18例五官非结核分枝杆菌病患者的临床特征及疗效分析  

Clinical characteristics and treatment outcomes of 18 patients with non-tuberculosis mycobacteria concerning eyes,ears,nose and throat

作　　者：简奕娈[1] 吴龙章[2] 古卓云[3] JIAN Yi-luan;WU Long-zhang;GU Zhuo-yun(Department of Ophthalmology and Otorhinolaryngology,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院五官科,510095 [2]广州市胸科医院检验科,510095 [3]广州市胸科医院病案室,510095

出　　处：《中国防痨杂志》2020年第3期255-258,共4页Chinese Journal of Antituberculosis

摘　　要：目的分析五官非结核分枝杆菌(NTM)病的临床特点、治疗方案及治疗效果。方法回顾性分析广州市胸科医院2010年1月至2013年1月确诊为五官NTM病的18例患者的临床资料,包括眼角膜NTM病5例、中耳NTM病6例、鼻咽NTM病2例、喉NTM病5例。收集其菌种鉴定结果、药物敏感性试验(简称"药敏试验")结果、临床特征、治疗方案及治疗结果,进行总结分析。结果眼角膜NTM患者主要表现为角膜溃疡。中耳NTM患者主要表现为鼓膜穿孔、流脓。鼻咽NTM以及喉NTM患者主要表现为鼻咽喉部的新生物,局部溃疡,分泌物增多。18例患者患处分泌物共分离出39株NTM,其中9例为龟-脓肿分枝杆菌复合群,7例为鸟-胞内分枝杆菌复合群,2例为偶发分枝杆菌。药敏试验结果显示对异烟肼、利福平、乙胺丁醇、链霉素、左氧氟沙星、莫西沙星、力克菲蒺、利福布汀、丙硫异烟胺、卷曲霉素、环丙沙星耐药。给予患者左氧氟沙星或者莫西沙星、硫酸阿米卡星、克拉霉素缓释片、盐酸克林霉素棕榈酸酯分散片、乙胺丁醇口服治疗,局部根据药敏试验结果使用了大环内酯类及氨基糖苷类药物。经治疗,18例患者皆病情好转,症状消失,病变部位愈合。结论五官NTM病患者大部分对抗结核药物耐药,在获得药敏试验结果之前应根据病变部位的特点与疗效及时局部加用硫酸阿米卡星;获取药敏试验结果后,通过全身联合用药和局部使用敏感药物,可以取得良好的治疗效果。Objective To analyze the clinical characteristics,therapeutic schemes and treatment effects of non-tuberculosis mycobacteria(NTM) diseases concerning eyes,ears,nose and throat(EENT).Methods Retrospective analysis on clinical data of 18 patients diagnosed with NTM diseases concerning EENT from January 2010 to January2013 in Guangzhou Chest Hospital was performed,including five cases with cornea NTM,six with auris media NTM,two with nasopharynx NTM and the rest five with larynx NTM Summary analysis was carried out based on the detailed record of strain identification,drug sensitivity results,clinical characteristics,therapeutic schemes and treatment effects.Results Patients with cornea NTM were mainly characterized with the clinical manifestation of corneal ulcers,those with auris media NTM were primarily accompanied by tympanic membrane perforation and purulent discharge,and the rest with nasopharynx NTM and larynx NTM mainly presented with neoformations,local ulcers and increasing secretions in nasopharynx and larynx.A total of 39 NTM strains were isolated from the secretions of 18 patients,of which 9,7 and 2 were Mycobacterium chelonae-abscessus complex,Mycobacterium aviumintracellulare complex and Mycobacterium fortuitum,respectively.Result of drug sensitivity indicated that the strains were resistant to isoniazide,rifampicin,ethambutol,streptomycin,levofloxacin,moxifloxacin,pasiniazid,rifabutin,protionamide,capreomycin and ciprofloxacin.Oral treatment was performed with levofloxacin or moxifloxacin,amikacin sulfate,clarithromycin sustained release tablets,clindamycin palmitate hydrochloride dispersible tablets and ethambutol,and local therapy was also performed with macrocyclic lipids and aminoglycosides according to the drug sensitivity.All the 18 patients finally got better with symptoms disappearing and lesion sites healing.Conclusion Most NTM diseases concerning EENT had resistance to the antituberculosis drugs.In light of the characteristics and treatment effects of lesion sites,local application of amika

关 键 词：分枝杆菌.非典型性 耳鼻咽喉疾病 疾病特征 微生物敏感性试验 治疗结果 

分 类 号：R446.5[医药卫生—诊断学]