南京某专科医院87例非结核分枝杆菌肺病患者的临床特征分析

Species identification and clinical characteristics analysis of clinical isolates of 87 non-tuberculous mycobacterium pulmonary disease in a specialized hospital in Nanjing

目的:了解南京某专科医院87例非结核分枝杆菌(non - tuberculous Mycobacterial ,NTM)肺病患者临床分离株的菌种分布和相关临床特征。方法:回顾性调查分析2017年6月至2018年8月该院非结核分枝杆菌肺病患者临床分离株的菌种分布和相关临床特征。结果:南京某专科医院NTM分离率是15.5%,患病率为56.5%。NTM肺病患者常见于男性,尤其是60岁以上老年男性,而女性患者多见于50~59岁。最常见致病菌株为胞内分枝杆菌(70.1%),其次为龟分枝杆菌龟脓肿亚种(11.5%)和鸟分枝杆菌(11.5%)。NTM肺病患者常见的高危因素为既往结核病史(64.4%)、人类免疫缺陷病毒(human immunodeficiency virus, HIV)阳性(19.5%)、支气管扩张(19.5%)、慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)(6.9%)、肝炎(5.7%)、糖尿病(4.6%)等。NTM肺病患者的临床症状多见咳嗽咳痰、发热、咯血、胸闷气喘等非特异性呼吸道症状,且临床症状与菌种无相关性,但气喘和咯血与性别具有相关性,男性更容易发生气喘,女性更容易发生咯血;咯血和胸闷与年龄具有相关性,年龄越大越容易出现咯血,年龄越小越容易出现胸闷。NTM患者的胸部影像学表现中最多的为类支气管扩张,占39.1%;其次肺部空洞和结节,各占 37.9%,空洞中基本为多发薄壁空洞,达90.9%。结论: NTM肺病与肺结核具有相似的临床表现,不容易鉴别。对有结核病、HIV阳性、支气管扩张、COPD等病史,胸部影像学表现为支气管扩张、肺部空洞和结节的患者,须排查NTM肺病,尽早进行菌种鉴定以指导临床治疗。

Objective: To understand the bacterial species distribution and relevant clinical characteristics of clinical isolates of 87 non- tuberculous Mycobacteria pulmonary disease (NTM- PD) patients in a specialized hospital of Nanjing. Methods: The strain distribution and related clinical characteristics of clinical isolates from patients with NTM- PD in the hospital from June 2017 to August 2018 were reviewed and analyzed retrospectively. Results: The NTM isolation rate was 15.5% in the specialized hospital in Nanjing, with a prevalence of 56.5%. NTM- PD patients were more frequent in males, especially in elderly male over 60 years old, while female patients were more common in 50 to 59 years old. The most common pathogenic strains were Mycobacterium intracellulare(70.1%), followed by Mycobacterium chelonei(11.5%) and Mycobacterium avium(11.5%). The common risk factors for NTM- PD patients were previous history of tuberculosis(64.4%), human immunodeficiency virus (HIV)positive(19.5%), bronchiectasis(19.5%), chronic obstructive pulmonary disease(COPD)(6.9%), hepatitis(5.7%), and Diabetes Mellitus(4.6%). The clinical symptoms of NTM- PD patients were non- specific respiratory symptoms, such as cough, sputum, fever, hemoptysis, chest distress and asthma, and there was no correlation between those clinical symptoms and bacteria species. However, asthma and hemoptysis were correlated with gender. The males were more prone to asthma, while females were more prone to hemoptysis. Hemoptysis and chest distress had relevance with the age. The older, the more likely hood of hemoptysis;while the younger, the more likely hood of chest distress. In the chest imaging manifestations, bronchiectasis was the most frequent, accounting for 39.1%, followed by pulmonary cavitation and nodules, accounting for 37.9%respectively, in which multiple thin- walled cavitation accounted for 90.9%. Conclusion: NTM- PD and tuberculosis have similar clinical manifestations. It s not easy to identify in clinical practice. It is necessary to alert the presence of NTM- PD with those who have previous history of tuberculosis, HIV- positive, bronchiectasis, chronic obstructive pulmonary disease, or chest imaging of bronchiectasis, pulmonary cavity and nodules. It is of great significance to identify the species as soon as possible for NTM patients in order to guide clinical treatment.