脓肿分枝杆菌肺病治疗效果及其影响因素分析  

Study on therapeutic effect of Mycobacterium abscessus pulmonary disease and its affecting factors

作　　者：张丽娜[1] 李轩 邓群益[1] 刘国辉[1] ZHANG Li-na;LI Xuan;DENG Qun-yi(Shenzhen Third People's Hospital,Shenzhen 518000,China)

机构地区：[1]深圳市第三人民医院

出　　处：《中国实用医药》2020年第2期16-18,共3页China Practical Medicine

基　　金：深圳市医学重点学科建设经费资助(结核病科)(项目编号：深卫计科教【2018】61号)

摘　　要：目的分析脓肿分枝杆菌肺病治疗效果及其影响因素。方法回顾性分析91例脓肿分枝杆菌肺病患者的临床资料,根据治疗结果分为治愈组(49例)和未愈组(42例)。观察患者的临床特征、治疗与随访情况、死亡情况及影响因素。结果①临床特征:在基础疾病上诊断为脓肿分枝杆菌肺病患者52例(57.1%);影像特征:肺部CT扫描显示13例(14.3%)病灶在1个肺野内, 78例(85.7%)累及2个及以上肺野。形态表现:26例(28.6%)伴空洞, 36例(39.6%)伴支气管扩张, 22例(24.2%)伴胸膜增厚,7例(7.7%)伴肺毁损。药物敏感试验显示脓肿分枝杆菌对一、二线常用抗结核药物的耐药率均>95%,异烟肼、对氨基水杨酸、链霉素、卷曲霉素、利福平、左氧氟沙星和乙胺丁醇耐药率为98.9%,利福布汀和丙硫异烟胺耐药率为97.8%。②治疗及随访情况:60例(65.9%)患者规则治疗并完成疗程, 31例(34.1%)患者存在不规则治疗情况。③死亡情况:未愈组患者中死亡1例(1.1%),死亡原因为感染性休克。④治疗效果的影响因素分析:单因素分析显示:两组年龄、基础疾病、肺野个数、支气管扩张因素比较,差异有统计学意义(P<0.05)。多因素分析显示:支气管扩张[OR=8.215, 95%CI=(2.974, 22.695), P<0.05]、不规则治疗[OR=2.859, 95%CI=(1.019, 8.025), P<0.05]是影响治疗效果的不利因素。结论脓肿分枝杆菌耐药率高,治愈率低,支气管扩张和不规则治疗是影响治愈的不利因素。Objective To analyze the therapeutic effect of Mycobacterium abscessus pulmonary disease and its affecting factors. Methods The clinical data of 91 patients with Mycobacterium abscessus pulmonary disease were analyzed retrospectively. According to the treatment results, they were divided into cured group(49 cases) and non-cured group(42 cases). The clinical characteristics, treatment and follow-up, death condition and influencing factors were observed. Results ①Clinical features: 52 cases(57.1%) were diagnosed as Mycobacterium abscessus pulmonary disease based on underlying disease. Image feature: CT scan showed that 13 cases(14.3%) were in 1 lung field, 78 cases(85.7%) involved 2 or more lung fields. Morphological manifestation: 26 cases(28.6%) were accompanied with cavity, 36 cases(39.6%) with bronchiectasis, 22 cases(24.2%) with pleural thickening and 7 cases(7.7%) with lung damage. Drug susceptibility tests showed that Mycobacterium abscessus resistance to first and second-line commonly used anti-tuberculosis drugs was> 95%. The drug resistance rate of isoniazid, p-aminosalicylic acid, streptomycin, capreomycin, rifampicin, levofloxacin and ethambutol was 98.9%, and rifabutin and propylthioisoniazid was 97.8%. ②Treatment and follow-up: 60 patients(65.9%) had regular treatment and completed the course of treatment, and 31 patients(34.1%) had irregular treatment. ③Death: 1 patient(1.1%) died in non-cured group, and the cause of death was septic shock. ④Influencing factors analysis: univariate analysis showed that there were statistically significant differences in age, underlying disease, number of lung fields, and bronchiectasis in the two groups(P<0.05). Multivariate analysis showed that bronchiectasis [OR=8.215, 95%CI=(2.974, 22.695), P<0.05] and irregular treatment [OR=2.859, 95%CI=(1.019, 8.025), P<0.05] were the adverse factors affecting the treatment effect. Conclusion Mycobacterium abscessus has high drug resistance rate and low cure rate. Bronchiectasis and irregular treatment are the adverse f

关 键 词：脓肿分枝杆菌 脓肿分枝杆菌肺病 治疗效果 影响因素 

分 类 号：R563[医药卫生—呼吸系统]