机械通气患者合并非结核分枝杆菌肺病的临床分析  

Clinical analysis of non-tuberculous mycobacterial pulmonary diseases in patients with mechanical ventilation

作　　者：杨淳[1] 陈思蓓[1] 席寅[1] 刘冬冬[1] 张容[1] 邱桂霞[1] 何为群[1] 黎毅敏[1] 刘晓青[1] Yang Chun;Chen Sibei;Xi Yin;Liu Dongdong;Zhang Rong;Qiu Guixia;He Weiqun;Li Yimin;Liu Xiaoqing(Department of Critical Care Medicine,Guangzhou Institute of Respiratory Disease,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong,China)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院重症医学科,510120

出　　处：《中华危重病急救医学》2019年第8期1033-1036,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81770079);国家科技重大专项(2017ZX10204401003).

摘　　要：目的分析机械通气患者合并非结核分枝杆菌(NTM)肺病的易患因素及临床特征。方法对2016年5月至2019年5月广州医科大学附属第一医院重症医学科(ICU)机械通气合并NTM肺病患者的临床资料进行回顾性分析,收集患者一般情况、基础疾病、症状体征、生化检查、抗酸染色、分枝杆菌培养和菌种鉴定结果、胸部CT资料等,总结机械通气患者合并NTM肺病的临床特征。结果共有12例机械通气合并NTM肺病患者,男性6例,女性6例;年龄37~82例,平均65岁;肿瘤5例(肺癌4例,纵隔肿瘤1例),肺移植术后2例(同时使用抗排药),有3种以上内科基础疾病〔包括高血压、糖尿病、冠心病、慢性阻塞性肺疾病(COPD)、支气管扩张、慢性肾功能不全〕5例。12例NTM肺病患者临床症状无特异性;胸部CT表现多样,可呈结节影、片状实变影和纤维条索状等,均未见空洞性病灶,但均出现胸腔积液;常规细菌感染的实验室指标无特异性,但淋巴细胞计数均降低。12例患者均可见分枝杆菌,菌种鉴定4例为鸟分枝杆菌,4例为龟分枝杆菌,2例为龟脓肿复合群分枝杆菌,2例为胞内非结核分枝杆菌。所有患者当出现气道分泌物抗酸染色阳性、结核杆菌核酸检测(TB-DNA)阴性时即给予抗NTM治疗,包括左氧氟沙星及克拉霉素口服治疗,最后均成功脱机拔管转出ICU。结论机械通气合并NTM肺病患者临床症状无特异性,胸部CT表现多样。存在免疫功能紊乱高危风险(如肿瘤、器官移植、口服免疫抑制剂)或有结构性肺病且接受机械通气的重症患者,当肺部感染难以控制,且出现胸腔积液、淋巴细胞计数减少,要警惕NTM引起的肺部感染。Objective To study the risk factors and the clinical characteristics of non-tuberculous mycobacterial(NTM)pulmonary diseases in patients with mechanical ventilation.Methods Retrospective survey was carried out in the patients with mechanical ventilation who combined with NTM pulmonary disease admitted to intensive care unit(ICU)of the First Affiliated Hospital of Guangzhou Medical University from May 2016 to May 2019.The general information,basic diseases,symptoms,signs,biochemical examinations,acid-fast stain test,mycobacterium culture and strain identification results,and chest CT data were collected to summarize the clinical characteristics of patients with mechanical ventilation combined with NTM pulmonary disease.Results There were 12 patients with mechanical ventilation combined with NTM pulmonary disease,6 males and 6 females,37-82 years old,with an average age of 65 years.In these 12 cases,patients with cancer(lung cancer were 4 cases,mediastinal tumor was 1 case)and after lung transplantation(use of anti-rejection drugs at the same time)were 5 and 2 respectively.Patients with at least 3 underlying diseases[included hypertension,diabetes,coronary heart disease,chronic obstructive pulmonary disease(COPD),bronchiectasis,chronic renal insufficiency]were 5.Clinical symptoms of the 12 cases were non-specific.The CT findings were not characteristic,including nodules,patchy infiltrations and fibrous streak.Pleural effusion was common among these subjects but nodular bronchiectatic patterns were absence.Routine laboratory indicators of bacterial infection were non-specific.But the number of lymphocytes of all cases decreased.Mycobacteria cultures were positive with the rapid growth of mycobacteria in these 12 cases.Mycobacterium avium(4 cases),Mycobacterium chelonae(4 cases),Mycobacterium chelonae-abscessus complex(2 cases)and Mycobacterium intracellulare(2 cases)were isolated.Anti-NTM therapy was given to the patients when the acid-fast staining test of their airway secretion was positive and the TB-DNA test was

关 键 词：机械通气 非结核分枝杆菌 肺部感染 

分 类 号：R459.7[医药卫生—急诊医学] R563[医药卫生—治疗学]