34例非结核分枝杆菌病的临床病理特征分析  

Clinicopathologic characteristics of 34 cases non-tuberculous mycobacterial disease

作　　者：张卉[1] 葛莉 张煜涵 冯瑞娥[1] Zhang Hui;Ge Li;Zhang Yuhan;Feng Ruie(Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100730,China;Department of Pathology,Weifang People’s Hospital(First Affiliated Hospital of Shandong Second Medical University),Weifang 261100,China)

机构地区：[1]中国医学科学院北京协和医院病理科,北京100730 [2]山东省潍坊市人民医院(山东第二医科大学附属第一医院)病理科,潍坊261100

出　　处：《中国防痨杂志》2024年第7期756-762,共7页Chinese Journal of Antituberculosis

摘　　要：目的:探讨非结核分枝杆菌(non-tuberculous mycobacteria,NTM)病的临床病理学特征。方法:回顾性收集北京协和医院2015年3月1日至2023年12月31日诊治且有病理送检记录的34例NTM病患者的临床资料及病理资料。将所有患者分为播散性NTM病组(14例)和非播散性NTM病组(20例),分析并比较两组患者的临床病理特征。结果:22例(64.71%,22/34)患者的致病菌为鸟-胞内分枝杆菌,6例(17.65%,6/34)患者的致病菌为龟-脓肿分枝杆菌,4例(11.76%,4/34)患者为堪萨斯分枝杆菌。病理组织学检查发现23例(67.65%,23/34)可见肉芽肿病变,其中,19例(82.61%,19/23)样本中的上皮样组织细胞排列均松散,7例(30.43%,7/23)样本中可见化脓性肉芽肿。5例(14.71%,5/34)可见富于核碎片的嗜碱性坏死,4例(11.76%,4/34)出现粉染的干酪样坏死,18例(52.94%,18/34)观察到多核巨细胞反应。5例(23.81%,5/21)抗酸染色阳性。结论:NTM病的病理组织学表现多样,以松散的上皮样肉芽肿为主要病理改变,常伴多核巨细胞反应,且化脓性肉芽肿较常见。Objective:To explore the clinicopathological characteristics of non-tuberculous mycobacterial(NTM)disease.Methods:Clinical and pathological data from 34 NTM patients who were diagnosed and treated in Peking Union Medical College Hospital between March 1,2015 and December 31,2023 were retrospectively collected.All patients were divided into disseminated NTM disease group(14 cases)and non-disseminated NTM disease group(20 cases).The clinicopathological characteristics of these groups were analyzed and compared.Results:Twenty-two patients(64.71%,22/34)were infected with Mycobacterium avium/intracellular;6 patients(17.65%,6/34)were caused by Turtle/Mycobacterium abscessus infection,and 4 patients(11.76%,4/34)were infected with Mycobacterium kansasii.Histopathological examination revealed granulomatous lesions in 23 cases(67.65%,23/34).Of these,19 cases(82.61%,19/23)exhibited loosely arranged granuloma,7 cases(30.43%,7/23)showed suppurative granulomas,and basophilic necrosis was found in 5 cases(14.71%,5/34).Pink-stained caseous necrosis was reviewed in 4 cases(11.76%,4/34),and multinucleated giant cell reaction was observed in 18 cases(52.94%,18/34).Positive acid-fast staining was identified in 5 out of 21 cases examined(23.81%,5/21).Conclusion:The pathological features of NTM disease are diverse,with loosely arranged epithelioid granulomas being the most common finding.These granulomas are often accompanied by multinucleated giant cell reactions and suppurative granuloma.

关 键 词：分枝杆菌 非典型性 病理学 临床 诊断 鉴别 

分 类 号：R52[医药卫生—内科学] R365[医药卫生—临床医学]