艾滋病合并非结核分枝杆菌肺病的病原谱、临床特征和耐药情况

Pathogenic spectrum, clinical features and drug resistance of pneumonia caused by nontuberculous mycobacteria in acquined immunodeficiency syndrome patients

目的了解艾滋病合并非结核分枝杆菌（NTM）肺病的病原谱、临床特征和耐药情况。方法采用回顾性研究分析广州市第八人民医院2008年1月至2015年12月住院部收治31例经支气管肺泡灌洗液培养确定NTM肺病艾滋病患者的临床资料，包括病原谱、临床特征和耐药情况等。比较鸟-胞内分支杆菌复合群（MAC）肺病与非MAC肺病的临床特征与耐药情况。采用t检验，计数资料采用7。检验。结果31例患者，男28例，女3例，年龄（40．9±10．3）岁，MAC感染（MAC组）14例，非MAC组（包括堪萨斯分枝杆菌、缓黄分支杆菌、苏尔加分枝杆菌、脓肿分支杆菌等）17例。两组年龄、性别构成的差异均无统计学意义（均P〉0．05），主要临床表现、实验室检查指标和临床转归均相似（均P〉0．05），临床表现常见发热、咳嗽、咳痰、消瘦、贫血，CD4^＋细胞计数〈50／μL，CT多显示胸腔淋巴结肿大与肺部斑片影，少见粟粒影、心包积液。MAC组对莫西沙星（10／14比4／17）、左氧氟沙星（14／14比8／17）、克拉霉素（11／14比7／17）的耐药率以及广泛耐药率（11／14比7／17）均明显高于非MAc组（均P〈0．05）。结论艾滋病合并NTM肺病以MAC为主，MAC肺病与非MAC肺病临床特征相似，但MAC耐药情况更严重。

Objective To explore the pathogen spectrum, drug resistance rate and clinical characteristics of pneumonia caused by non-tuberculous rnycobacteria （NTM） in acquined immunodeficiency syndrome （AIDS） patients. Methods The clinical data of 31 hospitalized AIDS patients with bronchoalceolar lavage flind （BALF） culture confirmed NTM pulmonary disease in Guangzhou No. 8 People＇ s Hospital from January, 2008 to February, 2015 were retrospectively analyzed, including pathogen spectrum, drug resistance rate and clinical characteristics. The clinical characteristics and drug resistance were compared between Mycobacteriurn avrnrn-intracellulare complex （MAC） pneumonia and the non- MAC pneumonia, and t test and chi-square test were used. Results Of the 31 AIDS patients,28 were male and 3 were female, with the mean age of 40.9 years old. The 31 NTM strains were consisted of 14 MAC strains and 17 non-MAC strains （including 4 M. kansasii strains, 3 M. lentiflavumstrains, 2 M. szulgai strains, 2 M. yongonense strains etc）. There was no significant difference between two groups in sex ratio, mean age, clinical manifestations, laboratory tests and treatment outcome （all P〈 0.05）. The major clinical manifestations included fever, productive cough, weight loss, anemia and low CD4＋ count （〈50μL）. Most patients showed thoracic lymphadenectasis and patchy shadows in lungs, and few patients had millet shadows and pericardial effusion. Compared with non-MAC strains, MAC strains had higher drug resistant rate of moxifloxacin （10/14 vs 4/17）, levofloxacin （14/14 vs 8/17）, and clarithromycin （11/14 vs 7/17）. More extensively drug resistance strains were seen in non-MAC strains compare with MAC strains （11/14 vs 7/17）. Conclusions MAC is the most common pathogen of NTM pulmonary disease in AIDS patients. The clinical features of pneumonia caused by MAC and non-MAC are similar, but drug resistance of MAC strains are more severe.