支气管镜分离检查患者鸟分枝杆菌复合群阳性与肺癌关系的临床研究

Clinical study of relationship between mycobacterium avium complex isolated by bronchoscopy and lung cancer

目的探讨肺癌患者中影响鸟分枝杆菌复合群(mycobacterium avium complex,MAC)阳性(感染)的危险性因素以及MAC阳性(感染)与肺癌特征的关系。方法选择2012年1月-2015年12月来我院行支气管镜下支气管灌洗液常规培养分枝杆菌患者265例,根据MAC培养阴阳性将肺癌患者划分为MAC阳性/非结核性分枝杆菌(non tuberlosis myeobactericum,NTM)阴性(A组,n=36)、MAC阴性/NTM阳性(B组,n=15)、MAC阴性/NTM阴性(C组,n=214),应用Logistic回归分析筛选出肺癌患者中影响MAC阳性(感染)的危险性因素。结果 265例肺癌患者中,36例检出MAC阳性,阳性率13.58%;检出78例NTM阳性,阳性率19.25%;MAC阴性/NTM阳性肺癌患者中检出9例萨斯分枝杆菌(M.kansasii)、6例脓肿分枝杆菌(M.abscessus);单因素回归分析显示,肺癌患者中女性、年龄是影响MAC阳性(感染)的危险性因素(P=0.025,P=0.033),肺癌患者有吸烟史、原发灶部位、病理组织类型、肿瘤分化程度、TNM分期与MAC阳性(感染)无显著性相关(P>0.05);多因素回归分析显示,肺癌患者中性别为女性(OR=0.386,95%CI=0.182-0.863,P=0.018)、年龄较大(OR=1.031,95%CI=1.001-1.092,P=0.028)是MAC阳性(感染)的危险性因素。结论性别为女性、年龄较大肺癌患者中MAC阳性(感染)的危险性显著增加,肺癌患者的癌症特征(原发灶部位、病理组织类型、肿瘤分化程度、TNM分期)与MAC阳性(感染)无关,提示临床医师更应密切关注肺癌患者性别、年龄及MAC菌种鉴定结果。

Objective To explore the risk factors of MAC positive （infection） in patients with lung cancer and the relationship between MAC positive （infection） and lung cancer characteristics. Methods 265 cases of Mycobacterium in our hospital were selected from 2012.1 to 2015.12. According to the MAC culture of positive and negative of the lung cancer, they were divided into the MAC positive/NTM negative group （ group A, n = 36） , the MAC negative/NTM positive group （group B, n = 15） and the MAC positive/NTM negative group （group C, n =214）. Logistic regression analysis was used to screen the effect of MAC positive （infection） and the risk factors in patients with lung cancer. Results In 265 lung cancer patients, there were 36 MAC positive cases （ 13.58% ）, 51 NTM positive cases （19.25%）, 9 cases of M. kansasii, and 6 cases of M. abscessus. Single factor regression analysis showed that female and age were MAC positive （infection） risk factors （ P = 0. 025, P = 0. 033 ）, and it had no significant correlation with history of smoking, primary tumor site, pathological type, tumor differentiation, TNM staging or MAC positive （infection） （ P 〉 0. 05 ）. Multi factor regression analysis showed that women （ OR = 0. 386, 95% CI =0. 182 -0. 863, P = 0. 018） and older （ OR = 1.031, 95% CI = 1. 001 - 1. 092, P = 0. 028 ） were MAC positive （infection） risk factors. Conclusion Lung cancer in female, older patients with MAC positive （infection） risk increases significantly, and their characteristics （location of the primary tumor, pathological type, tumor differentiation, TNM staging） have no correlation with MAC positive （infection）, which indicates that clinicians should pay close attention to patient＇s sex, age and MAC strain identification results.