社区获得性快生长型非结核分支杆菌肺病58例分析

Analysis of 58 Cases with Social Acquired Rapid-Growth Typed Nontuberculous Mycobacterium Pulmonary Disease

目的 了解社区获得性快生长型非结核分支杆菌肺病的临床特点。方法 对 1986年 1月～ 1997年间痰抗酸杆菌培养阳性 390 7例中 ,经菌型鉴定证明为快生长型非结核分支杆菌肺病者 5 8例进行回顾性分析。结果 按 Runyon分类法 ,感染 型偶然分支杆菌 38例 ,龟分支杆菌 2 0例 ;男 39例 ,女 19例 ;病程 8～ 40年 ;主要症状咳嗽、咯白粘痰、咯血、发热 ;X线胸片两侧受累者 6 0 .3% ,左侧 2 4.1% ,右侧 15 .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 ,而对卡那霉素耐药率相对较低。结论 快生长型非结核分支杆菌肺病者病程长、症状不特异、耐药率高、抗结核治疗疗效差。

OBJECTIVE To study the clinical characteristics of social acquired rapid growth typed nontuberculous mycobacterium (RNTM) pulmonary disease. METHODS Cases with RNTM pulmonary disease, diagnosed through identification of mycobacterium strains and isolated from 3901 sputum culture positive cases, were retrospectively analysed from Jan 1986 to Dec 1997. RESULTS According to Runyon classification, there were 38 cases with M,ycobacterium fortuitum and 20 cases with M.chelonae in type Ⅵ. The main clinical symptoms included cough, expectoration with white mucous sputum, hemoptysis and fever, in X ray chest film were seen lesions bilaterally in 60.3% cases, 24.1% in left side and 15.5% in the right. The resistant rates were high to isoniazid, streptomycin, ethambutol, sodium paraaminosalicylate and protionamide, while the rate was relatively lower to kanamycin. The sputum negative conversion was 31%. CONCLUSIONS the RNTM pulmonary disease was characterized by long course of disease, nonspecific symptoms, high resistant rate and unsatisfactory therapeutic efficacy.