社区获得性快生长型非结核分支杆菌肺病58例临床分析

Analysis of 58 cases with community-acquired rapidly growing nontuberculous mycobacteria(RNTM) pulmonary disease

目的 了解社区获得性快生长型非结核分枝杆菌肺病的临床特点。方法 对 1 986年 1月至1 997年 1 2月间痰抗酸杆菌培养阳性 3 90 7例中 ,经菌型鉴定证明为快生长型非结核分枝杆菌肺病 58例进行回顾性分析。结果 按Runyon分类法 ,感染Ⅳ型偶然分枝杆菌 3 8例 ,龟分枝杆菌 2 0例。男 3 9例 ,女 1 7例 ,病程 8～ 4 0年。主要症状为咳嗽、咳白粘痰、咯血、发热。X线胸片两侧受累者 60 .3 % ,左侧 2 4 1 % ,右侧 1 5.5%。对异烟肼、链霉素、乙胺丁醇、利福平、对氨基水杨酸、丙硫异烟胺耐药率很高 ,对卡那霉素耐药率相对较低。结论 快生长型非结核分枝杆菌肺病病程长 ,症状不特异 ,耐药率高 ,抗结核治疗疗效差。

Objective To study the clinical characterisitcs of community-acquired rapidly growing nontuberculous mycobacterium(RNTM)pulmonary disease.Methods 58 cases with RNTM pulmonary disease,diagnosed through identification of mycobacterium strains and isolated from 3 901 sputum culture positive cases,were retrospectived from Jan.1986 to Dec.1997.Results According to Runyon classification,there were 38 cases with M.Fortuitumin and 20 cases with M.Chelonae in type Ⅳ,39 cases in male and 17 in female.The main clinical symptoms included cough,expectoration with white mucous sputum,haemoptysis and fever,60.3% cases in X-ray chest film were seen lesions bilaterally,24.1% in left side and 15.5% in the right.The resistant rates were high to isoniazid,streptomycin,ethambutol,sodium paraaminosalicylate and prothionamide,while lower to kanamycin and comparatively.The sputum negative conversion was 31%.Conclusion The RNTM pulmonary disease was characterized by long course,nonspecific symptoms,high resistant rate and unsatisfactory therapeutic efficacy.