非结核分枝杆菌肺病21例报告并文献复习

Literature review and report on 21 cases of non-tubercular ramose bacilli pulmonary disease

目的 研究非结核分枝杆菌肺病的临床表现、耐药情况及化疗效果。方法 分析 2 0 0 0年 8月至2 0 0 2年 10月间太原市结核病医院痰培养分枝杆菌阳性、菌型鉴定为非结核分枝杆菌、并作药敏测定的 2 4例 ,并对其中 2 1例临床表现及治疗效果进行总结。结果 非结核分枝杆菌肺病的临床表现酷似肺结核 ,耐药发生率高。耐H、P发生率为 79.2 % ,耐 Z、E发生率为 75 .0 % ,耐 S发生率为 5 8.3% ,耐 R发生率为 2 9.1%。其中同时对 6种药物耐药者 4例 ,同时对 5种药物耐药者 5例 ,同时对 4种药物耐药者 8例 ,同时对 3种药物耐药者 3例 ,同时对 2种药物耐药者 1例 ,对 1种药物耐药者 2例 ,对 6种药物全敏感者 1例。结论 非结核分枝杆菌肺病确诊靠菌型鉴定。治愈需联合用药 18～ 2 4个月 ,有适应症时可考虑手术治疗。

Objective To investigate clinical manifestations, drug endurance and effects of the chemotherapy on non-tubercular ramose bacilli pulmonary disease.Methods A total of 24 patients who had been with the hospital between August 2000 and October 2002 participated in the study. All patients' sputum had been cultured and tested, and confirmed with non-tubercular ramose bacilli. They were also taken on drug sensitivity test. Twenty-one of the 24 patients had been evaluated on their clinical manifestations and the treatment effects of using drugs. Results Non-tubercular ramose bacilli pulmonary disease was similar to tuberculosis in terms of clinical manifestations, but the former had a higher rate of drug endurance than the latter. Specifically, the drug endurance rate for H and P, for Z and E, for S, and for F, respectively, were 79.2%, 75.0%, 58.3% and 29.1%. There were some cases showing drug endurance for multiple drugs: 4 cases for 6 drugs, 5 cases for 5 drugs, 4 cases for 8 drugs and 1 case for 2 drugs.Conclusion Non-tubercular ramose bacilli pulmonary disease can be diagnosed through the confirmation of the existence of the bacteria. The course of the treatment runs between 18 and 24 months.Surgery should be considered when the condition is permitted.