鸟胞内分枝杆菌复合群肺病患者23例临床分析

Clinical manifestations and treatment adverse effects of mycobacterium avium-intracellulare complex pulmonary diseases

目的分析鸟胞内分枝杆菌复合群(MAC)肺病的临床表现和治疗的不良反应。方法回顾性分析2010～2012年首都医科大学附属北京胸科医院新诊断的23例MAC肺病的临床表现以及9例接受治疗病例的短期疗效。结果 14例男性MAC肺病表现为上叶空洞型,9例女性MAC肺病表现为结节支气管扩张型。MAC肺病的主要影像特点是多发微结节(10/23)、多发支气管扩张(9/23)、树芽征(8/23)、空洞(15/23)、肺实变(5/23)、结节(8/23)和肺体积缩小(8/23)。5例含利福布汀方案治疗的患者,3个月后症状改善3例,影像好转2例,痰抗酸杆菌阴转2例,4例含利福平方案治疗的患者,3个月后症状改善3例,影像好转2例,痰抗酸杆菌阴转1例。结论 MAC肺病的主要临床表现形式是上叶空洞型和结节支气管扩张型,前者主要见于男性患者,后者主要见于女性患者。含利福平或利福布汀的治疗方案对患者具有一定疗效。

Objective To analyze the clinical manifestations and treatment adverse effects of mycobacterium avium-intracellulare complex(MAC)pulmonary diseases.Methods The clinical manifestations of 23 patients with MAC,and treatment adverse effects of 9 cases were retrospectively analyzed.All cases were diagnosed from 2010 to 2012 in Beijing Chest Hospital,Capital Medical University.Results Fourteen male patients with MAC pulmonary disease showed upper lobe cavity type and 9 female patients showed nodular bronchiectasis type.The main imaging characteristics of MAC pulmonary disease include multi micronodules(10/23),multi bronchiectasis(9/23),tree in bud sign(8/23),cavity(15/23),pulmonary consolidation(5/23),nodule(8/23),and collapse of lung(8/23).5 cases treated with regimen including rifabutin.After 3 months therapy,3 of them got improvement of symptom,2 getting improvement of radiographic examination,and 1 getting improvement of sputum bacterial examination.4 cases treated with regimen including rifapicin.After 3 months therapy,3 of them got improvement of symptom,2 getting improvement of radiographic examination,and 1 getting improvement of sputum bacterial examination.Conclusions Upper lobe cavity type and nodular bronchiectasis type are the main manifestation of MAC pulmonary diseases.Usually,male patients with MAC pulmonary disease shows upper lobe cavity type and female patients show nodular bronchiectasis type.Regimen including rifapicin or rifabutin is effective against MAC pulmonary diseases.