胞内分枝杆菌型NTM肺病二例误诊原因分析

Misdiagnosis Analysis of Pulmonary Disease by Mycobacterium Intracellulare NTM Infection in Two Patients

目的分析非结核分枝杆菌(non-tuberculous mycobacteria,NTM)肺病误诊原因。方法回顾分析误诊为肺结核的NTM肺病2例临床资料。结果2例均因咳嗽咳痰就诊,2次痰涂片抗酸杆菌均阳性,胸部CT检查均有肺尖部胸膜下薄壁空洞,肺部散在斑片影伴支气管扩张,初步诊断为肺结核,抗结核治疗均无效,外院行痰细菌培养均提示胞内分枝杆菌生长,明确诊断为NTM肺病。按药物敏感试验结果予抗NTM治疗,患者症状逐步消失,肺部病变逐步吸收好转,复查痰细菌培养3次均阴性,1例疗程1年半,1例疗程2年,随访至今病情稳定无复发。结论NTM肺病临床表现与肺结核病相似,但发病率低,临床少见,易误漏诊,临床医生应提高警惕,及时行NTM检测是确诊的关键。

Objective To analyze misdiagnosis causes in two patients with pulmonary non-tuberculous mycobacteria(NTM)disease.Methods Clinical data of 2 patients with pulmonary NTM disease misdiagnosed as pulmonary tuberculosis were retrospectively analyzed.Results Both patients presented with cough and expectoration.Results of sputum smear were positive for acid-fast bacilli twice,and lung CT examination showed subpleural thin-walled cavity of apex pulmonis and scattered patch shadow in lung with bronchiectasis,and then initial diagnosis was tuberculosis,but anti-tuberculosis therapy was ineffective.Pulmonary NTM disease was confirmed according to mycobacteria intracellulare growth in further sputum culture results in another hospital.Anti-NTM therapy was given according to results of drug sensitivity test,and then symptoms of patients were gradually disappeared.Pulmonary lesions were gradually absorbed and improved,and results for re-examination sputum culture of 3 times were negative.Course of treatment for one patient was one and a half years,and 2 years for the other patient.The patients'conditions were stable without recurrence by follow-up to date.Conclusion Clinical manifestations of pulmonary NTM disease are similar to those of pulmonary tuberculosis,but the incidence rate is low and it is rare in clinical practice,therefore,it is easy to be misdiagnosed or missed.Thus,clinicians should raise the awareness,and timely NTM examination is the key for final diagnosis.