蟾分枝杆菌肺病三例并文献复习  

Mycobacterium xenopi Pulmonary Disease:Report of 3 Cases and Literature Review

作　　者：孔瑶瑶 姜广路[2] 黄海荣[2] 车南颖[3] 段鸿飞[1] Kong Yaoyao;Jiang Guanglu;Huang Hairong;Che Nanying;Duan Hongfei(不详;Department of Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核科,101149 [2]北京市结核病胸部肿瘤研究所结核病临床实验室 [3]首都医科大学附属北京胸科医院病理科

出　　处：《结核病与胸部肿瘤》2021年第4期269-274,共6页Tuberculosis and Thoracic Tumor

基　　金：国家科技重大专项重大新药创制专项(2017ZX09304009)。

摘　　要：目的分析蟾分枝杆菌肺病的临床特点、影像特点和预后,以期提高诊断和治疗水平。方法以“Mycobacterium xenopi,pulmonary disease”为检索词,在PubMed数据库进行检索,从2007年2月15日至2021年2月21日共检索到国外病例1264例,在万方数据库以“蟾分枝杆菌,肺病”为检索词,从2007年2月15日至2021年2月21日检索到相关文献0篇;在中国知网数据库以“蟾分枝杆菌,肺病”为检索词,从2007年2月15日至2021年2月21日检索到相关文献1篇,参照2007年美国胸科学会发布的非结核分枝杆菌肺病诊断标准,判定为不符合蟾分枝杆菌肺病的诊断。阅读文献入选1264例及本文病例,共1267例进行文献复习。结果3例蟾分枝杆菌肺病患者均为合并肺部基础疾病的中老年男性,以咳嗽.咳痰为主诉,胸部影像检查以空洞为主要表现,痰涂片抗酸染色阳性,痰Xpert MTB/RIF阴性,痰分枝杆菌培养及菌种鉴定至少2次发现蟾分枝杆菌。尽管经过化学治疗,病例1和病例2分别在确诊4年和2年后死亡,病例3在治疗30个月后痰分枝杆菌培养持续阴性,呼吸道症状减轻、胸部CT示病灶缩小,判定为治愈。结论蟾分枝杆菌肺病临床表现不典型,对痰涂片抗酸染色阳性但痰Xpert MTB/RIF和分枝杆菌培养阴性的患者,应注意排除蟾分枝杆菌肺病。该病疗效欠佳,值得临床医生重视。Objective To analyze the clinical manifestations,radiographic characteristics and prognosis of Mycobacterium xenopi pulmonary disease,in order to improve diagnosis and treatment of the disease.Methods Using"Mycobacterium xenopi,pulmonary disease"as the search term,from February 15,2007 to February 21,2021,a total of 1264 cases were retrieved in the PubMed database.In the Wanfang database,using"Mycobacterium xenopi,pulmonary disease"as the search term,from February 15,2007 to February 21,2021,no related document was retrieved.In the CNKI database."Mycobacterium xenopi,pulmonary disease"was used as the search term,and one relevant case report was retrieved,but did not meet the diagnostic criteria of Mycobacterium xenopi pulmonary disease issued by American Thoracic Society in 2007.The 1264 cases from the literature and 3 cases of our institution were used for review.Results Our 3 cases were elderly males complaining of cough and expectoration,and had underlying lung diseases.The imaging examination showed cavitary lesions.All of them had positive sputum smear for acid-fast bacillus and negative Xpert MTB/RIF examination.Mycobacterium xenopi was isolated at least 2 times from sputum samples.Although prescribed with chemotherapy,case 1 and case 2 died 4 years and 2 years later,respectively,after the diagnosis.Case 3 got sputum conversion,symptom improvement and radiographic responses after 30-month chemotherapy.Conclusions The clinical manifestations of Mycobacterium xenopi pulmonary disease are atypical.For patients with positive sputum smear for acid-fast bacillus and negative Xpert MTB/RIF examination and conventional mycobacterial culture.Mycobacterium xenopi pulmonary disease should be considered.The disease deserves further attention from clinicians due to poor prognosis.

关 键 词：非结核分枝杆菌 分枝杆菌 蟾 肺疾病 

分 类 号：R44[医药卫生—诊断学]