某综合医院非结核分枝杆菌病临床特点分析及菌种分布研究

Analysis of the clinical characteristics and species distribution of non-tuberculous mycobacteria in a general hospital

目的探讨非结核分枝杆菌(NTM)病的临床特点及菌种分布。方法回顾性分析2014年1月至2018年12月北京协和医院诊治的NTM病临床-影像-病原学资料,非结核分枝杆菌培养阳性532例,这些NTM标本来自453例患者,符合诊断标准,有确切病历资料并进行菌种鉴定有75例,男38例,女37例,年龄(50.8±16.2)岁,分析统计其临床表现、影像学特点、菌种鉴定及治疗情况。结果75例NTM病,鸟/胞内分枝杆菌43例(57.3%),龟/脓肿分枝杆菌18例(24.0%),堪萨斯分枝杆菌7例(9.3%)。64.0%患者存在合并症(48/75),最常见的是既往结核病史,占25.3%(19/75),其次是支气管扩张,占18.7%(14/75)。最常累及的器官是呼吸系统,占82.7%(62/75),其次是血流感染,占25.3%(19/75)。除呼吸系统外,鸟/胞内分枝杆菌复合群(MAC)常常合并血流感染,而快速生长分枝杆菌(RGM)更常见淋巴结及皮肤软组织感染。咳嗽/咳痰是NTM肺病最常见的临床表现,占77.4%(48/62),其次是发热、呼吸困难。最常见的影像学表现为结节41.9%(26/62)、支气管扩张37.1%(23/62)和纤维空洞24.2%(15/62)。播散性NTM病中,94.7%(18/19)存在基础疾病,89.5%(17/19)合并长期免疫抑制。结论NTM病最常见的菌种是鸟/胞内分枝杆菌,最常累及呼吸系统,既往结核病史可能增加NTM病风险。

Objective To summarize the clinical characteristics and species distribution of nontuberculous mycobacteria(NTM).Methods We conducted a retrospectively chart review of 453 adult patients with 532 positive cultures with NTM diagnosed and treated in Peking Union Medical College Hospital from January 2014 to December 2018.The information including clinical findings,imaging and etiological data were obtained from clinical examination system.Among these 453 patients,75 cases met the diagnostic criteria for NTM,with detailed clinical data,culture results and radiological images.Of these patients,38 were males and 37 were females,with an average age of(50.8±16.2)years.Clinical manifestations,imaging features,NTM species and treatment were analyzed.Results Among 75 NTM patients,43 cases(57.3%,43/75)were infected with Mycobacterium avium Complex(MAC)/intracellular,18 cases(24.0%,18/75)with Mycobacterium turtle/abscess,and 7 cases(9.3%,7/75)with Mycobacterium kansasii.Comorbidities existed in 64.0%patients(48/75).The top two common comorbidities were previous tuberculosis(25.3%,19/75)infection and clinical bronchiectasis(18.7%,14/75).After the respiratory disease(82.7%,62/75),we identified bloodstream as the most frequent manifestation of NTM infection(25.3%,19/75).MAC was often associated with infection in respiratory system and bloodstream,while rapidly growing mycobacteria(RGM)was more commonly detected in lymph nodes and skin and soft tissues.Cough/expectoration(77.4%,48/62)was the most common clinical symptom of NTM disease,followed by fever and dyspnea.The frequent imaging findings were nodules(41.9%,26/62),bronchiectasis(37.1%,23/62),and fibrous cavities(24.2%,15/62).In disseminated NTM disease,94.7%(18/19)patients had underlying diseases and 89.5%(17/19)patients had long-term immunosuppression.Conclusion The most common NTM species was Mycobacterium avium/intracellular in our series.The predominant infected organ was the respiratory system.Previous tuberculosis history likely increased the risk of infection.