播散性非结核分枝杆菌病的临床和实验室检查特征

Clinical and Laboratory Characteristics of Disseminated Non-tuberculous Mycobacterial Disease

目的了解非艾滋病患者播散性非结核分枝杆菌(NTM)病的临床、实验室检查特征及疾病预后。方法回顾性分析2012年1月至2018年10月在北京协和医院确诊的播散性NTM病患者的临床资料、实验室检查结果、治疗方案及其预后。结果23例非艾滋病播散性NTM病患者中,21例存在基础疾病,以风湿免疫病(7例)最常见。主要表现为发热(23例)。辅助检查提示多存在贫血[血红蛋白(85.78±25.47)g/L]、低白蛋白血症[白蛋白29(27~32)g/L];血沉[(85.73±43.78)mm/h]和超敏C反应蛋白[(112.00±70.90)mg/L]升高及淋巴细胞计数降低[0.69(0.29~2.10)×10^9/L]。淋巴细胞亚群分析提示CD4+T细胞[213(113~775)个/μl]、CD8^+T细胞[267(99~457)个/μl]、B淋巴细胞[39(4~165)个/μl]、NK细胞[88(32~279)个/μl]降低和CD8^+T细胞的D抗原相关人类白细胞抗原(HLA-DR)、CD38表达比例[HLA-DR^+CD8^+/CD8^+60(40~68)%和CD38^+CD8^+/CD8^+81(65~90)%]升高。最常见病原体为胞内分枝杆菌(6例)。死亡患者淋巴细胞、CD8^+T细胞、B细胞和NK细胞计数低于存活患者(P值分别为0.045、0.045、0.032和0.010)。结论非艾滋病患者播散性NTM病主要表现为发热、贫血、低蛋白血症、炎症指标升高,多发生于有基础病和免疫功能下降患者。淋巴细胞、CD8^+T淋巴细胞、B细胞计数和NK细胞下降患者可能更易死亡。

Objective To explore the clinical and laboratory characteristics and the prognosis of disseminated non-tuberculous mycobacteria(NTM)diseases in human immunodeficiency virus(HIV)negative patients. Methods Cases of disseminated NTM disease were retrospectively collected in Peking Union Medical College Hospital from January 2012 to October 2018.Clinical manifestations,laboratory findings,treatment,and prognosis of these cases were retrieved from the electronic medical record system. Results Among the 23 HIV negative patients with disseminated NTM disease,21 had underlying diseases,with rheumatoid immune disease( n =7)as the most common one.The main clinical manifestation was fever ( n =23).Laboratory tests showed anemia [hemoglobin(85.78±25.47)g/L],hypoalbuminemia [albumin 29(27- 32)g/L],elevated erythrocyte sedimentation rate [(85.73±43.78)mm/h] and hypersensitive C-reactive protein [(112.00± 70.90)mg/L],and reduction of lymphocyte count [0.69(0.29- 2.10)×10^9 /L].Lymphocyte subset analysis indicated reduction in CD4^+ T cells [213(113- 775)/μl],CD8 + T cells [267(99- 457)/μl],B cells [39(4- 165)/μl],and NK cells [88(32- 279)/μl] and elevation of human leukocyte antigen-D related(HLA-DR),and CD38 expression in CD8 ^+ T cells [HLA-DR ^+ CD8 +/CD8^+,60(40- 68)%;CD38^+ CD8 ^+/CD8^+,81(65- 90)%].The most common species of NTM was Mycobacterium intracellular ( n =6).Lymphocyte,CD8^+ T cell,B cell,and NK cell counts were significantly lower in dead patients than surviving patients( P =0.045, P =0.045, P =0.032,and P =0.010,respectively). Conclusions Disseminated NTM disease in HIV negative patients is mainly manifested as fever,anemia,hypoalbuminemia,and elevated inflammatory indicators.It is more likely to occur in immunocompromised patients.Patients with decreased lymphocytes,CD8^+ T cells,B cells and NK cells tend to have a poor prognosis.