非结核分枝杆菌肺病与肺结核患者的临床特征及危险因素分析

Analysis of clinical features and risk factors in patients with non-tuberculosis mycobacterial pulmonary disease and patients with pulmonary tuberculosis

目的分析非结核分枝杆菌肺病(NTM-PD)患者临床特征及危险因素。方法选择2014年1月至2018年1月该院92例NTM-PD患者为NTM-PD组,同期入院的184例肺结核患者为肺结核组。回顾性分析比较两组临床症状、胸部CT影像学特征、危险因素、结核杆菌纯蛋白衍生物(PPD)试验与药敏试验结果。结果两组患者年龄、吸烟、咳嗽、咯血、支气管扩张、慢性阻塞性肺疾病、肺内空洞占比差异有统计学意义(P<0.05),两组性别、免疫力低下比例差异无统计学意义(P>0.05),NTM-PD组空洞和增殖性病灶占比显著高于肺结核组(P<0.05),干酪坏死灶、胸腔积液占比显著低于肺结核组(P<0.05),NTM-PD组PPD试验阴性和弱阳性占比显著高于肺结核组(P<0.05),阳性、强阳性占比显著低于对照组(P<0.05),NTM-PD组痰涂片阳性率显著高于肺结核组(P<0.05),NTM-PD组对抗结核药物一种或以上耐药者、耐异烟肼、耐利福平者占比显著高于肺结核组(P<0.05)。年龄45~60岁(OR=2.541)、年龄大于60岁(OR=4.28)、支气管扩张(OR=3.84)、慢性阻塞性肺疾病(OR=3.14)、肺内薄壁空洞(OR=2.87)是NTM-PD的危险因素。结论NTM-PD与肺结核患者的临床特征有一定差异,其咳嗽咯血、胸部CT空洞、PPD试验阴性和弱阳性、对抗结核药物一种或以上耐药、耐异烟肼、耐利福平痰涂片阳性表现更多,而支气管扩张、慢性阻塞性肺疾病患者患NTM-PD的风险显著增加。

Objective To analyze the clinical features and risk factors in the patients with non-tuberculosis mycobacterial pulmonary disease (NTM-PD). Methods Ninety-two patients with NTM-PD in this hospital from January 2014 to January 2018 were selected as the NTM-PD group and contemporaneous 184 inpatients with pulmonary tuberculosis served as the tuberculosis group.Then the clinical symptoms,chest CT imaging characteristics,risk factors,mycobacterium tuberculosis pure protein derivative (PPD) test and drug sensitivity test results were retrospectively analyzed and compared between the two groups. Results The proportions of age,smoking history,cough,hemoptysis,bronchiectasis,chronic obstructive pulmonary disease and intrapulmonary cavity showed statistically significant difference between the two groups ( P <0.05).The proportions of cavity and proliferative lesions in the NTM-PD group were significantly higher than those in the pulmonary tuberculosis group ( P <0.05),while the proportions of caseous necrosis lesions and pleural effusion were significantly lower than those in the pulmonary tuberculosis group ( P <0.05).The proportions of PPD test negative and weak positive in the NTM-PD group were significantly higher than those in the pulmonary tuberculosis group ( P <0.05),and the proportions of positive and strong positive were significantly lower than those in the control group ( P <0.05).The positive rate of sputum smear in the NTM-PD group was significantly higher than that in the pulmonary tuberculosis group ( P <0.05).The proportions of resistance to one kind or more anti-tuberculosis drugs,resistance to isoniazid(H) and rifampicin (R) in the NTM-PD group were significantly higher than those in the pulmonary tuberculosis group ( P <0.05).The risk factors for NTM-PD were the age 45-60 years ( OR =2.541),age over 60 years ( OR =4.28),bronchiectasis ( OR =3.84),chronic obstructive pneumonia ( OR =3.14) and intrapulmonary thin wall cavity ( OR =2.87). Conclusion The clinical characteristics in the patients with NTM-PD are different from those in the patients with pulmonary tuberculosis.The NTM-PD have many manifestations such as cough,hemoptysis,chest CT cavity,PPD test negative and weak positive,resistance to one or more anti-tuberculosis drugs,HR resistance and sputum smear positive.The risk of NTM-PD in the patients with bronchiectasis and chronic obstructive pulmonary disease is significantly increased.