摘要
目的对苏州地区非结核分枝杆菌肺病((nontuberculous mycobacteria,NTM))临床特点、耐药特点进行分析总结,以提高NTM肺病诊疗水平。方法选取苏州市第五人民医院2014年9月至2016年9月64例非结核分枝杆菌肺病患者为研究对象,对患者临床资料(包括年龄、性别、既往病史、症状、影像学)、实验室检查(包括γ-干扰素释放实验、痰抗酸杆菌涂片、结核分枝杆菌TB-DNA痰液检测、痰结核分枝杆菌培养)、治疗方案选择、治疗期间药物不良反应及治疗效果进行回顾性分析。结果非结核分枝杆菌肺病以老年男性多见,通常合并基础肺病如支气管扩张、矽肺、慢性阻塞性肺病患者容易好发,临床症状及影像学表现与肺结核相似但病情进展较慢,γ-干扰素释放实验多为阴性(83.0%),痰抗酸杆菌涂片阳性率高(66.0%)及结核分枝杆菌TB-DNA痰液检测有助于早期诊断,耐药严重,耐药率由高到低分别为INH(98.4%)>PAS(95.3%)>SM(73.4%)>Lfx(82.8%)=RFP(82.8%)>Am(73.4%)>EMB(56.3%)>Pto(40.6%)。患者治疗期间药物副反应大,治疗效果差。结论对于老年患者,特别是合并基础肺疾病如支气管扩张、慢阻肺等查痰涂片找抗酸杆菌阳性及常规抗结核后治疗效果差的肺结核患者,均需警惕NTM肺病可能。因NTM与肺结核有很多相似点,早期易被误诊为肺结核,因此需及时关注早期疑似非结核分枝杆菌肺病患者的NTM培养报告及药敏试验结果,并根据药敏结果调整治疗方案。
Objective To evaluate the clinical features and characteristics of drug resistance of non-tuberculous mycobacterial(NTM)lung disease in Suzhou,in order to improve the level of diagnosis and treatment.Methods 64 patients identified NTM lung disease from December 2014 to September 2016 were selected.The contents of the investigation consisted the clinical data(age,gender,symptoms,medical imageology),laboratory examination(EGRAs,acid fast bacilli in sputum smear,TB-DNA,drug susceptibility test results),the choice of the therapeutic scheme,and adverse reactions during the therapy.Results Most cases were elderly onset,especially these patients with bronchiectasis,COPD,and silicosis disease.The clinical features and imaging characteristics were similar to pulmonary tuberculosis,but lighter.Most EGRAs were negative reaction(83.0%).The positive rate of acid fast bacilli in sputum smear and TB-DNA were higher with high resistance rate,and the drug resistance rate from high to low in order,were INH(98.1%)>PAS(96.2%)>SM(94.2%)>Lfx(79.2%)=RFP(79.2%)>Am(62.2%)>EMB(48.4%)>Pto(32.8%).There were severe adverse reactions,and treatment effect was poor.Conclusion For elderly patients,especially those with bronchiectasis,COPD,silicosis disease,who have positive acid fast bacilli in sputum smear or poor outcomes of treatment,should be alerted to have co-infection of NTM.Therefore,the clinical symptoms of mycobacterial(NTM)lung disease are similar with symptoms of pulmonary tuberculosis,which is easily misdiagnosed.It should timely pay attention to those patient’s drug-resistance test results,and adjusting therapeutic scheme according to its results.
作者
吴海燕
吴妹英
WU Hai-yan;WU Mei-ying(the Fifth People’s Hospital of Suzhou,Suzhou,Jiangsu 215000,China)
出处
《临床肺科杂志》
2018年第4期628-631,共4页
Journal of Clinical Pulmonary Medicine
基金
苏州市临床重点病种诊疗技术专项项目(No LCZX201514)
苏州市科技局民生科技项目(No SS201541
SS201656)
江苏省青年医学人才项目(No QNRC2016226)
关键词
苏州
非结核分枝杆菌肺病
临床特点
耐药
Suzhou
non-tuberculous mycobacterial(NTM)lung disease
clinical features
drug resistance
