福州地区非结核分枝杆菌肺病临床特征

Clinical characteristics of non-tuberculous mycobacterial pulmonary disease in Fuzhou

目的了解和分析福州地区非结核分枝杆菌(NTM)肺病的菌种分布及临床特征,为NTM肺病的临床诊治提供参考依据。方法回顾性分析2018年1月—2020年1月福建省福州肺科医院送检痰或支气管肺泡灌洗液(BALF)标本培养出分枝杆菌的患者病历资料。分析确诊NTM肺病患者的菌种分布及相关临床特征。结果共有确诊NTM肺病患者249例,NTM与结核分枝杆菌混合感染10例(4.0%)。249例NTM肺病患者中,中老年人多见,女性略多于男性。最常见的致病菌种为胞内分枝杆菌60.6%(151株),其次为鸟分枝杆菌17.7%(44株)和龟/脓肿分枝杆菌17.7%(44株)。NTM肺病常见的易感因素依次为支气管扩张70.3%(175例),既往结核病史28.5%(71例),尘肺14.5%(36例),慢性阻塞性肺疾病(COPD)11.2%(28例),肿瘤病史4.8%(12例),糖尿病4.4%(11例)等。男性更易合并COPD,女性更易合并支气管扩张。NTM肺病的临床症状无特异性,常表现为咳嗽、咳痰、咯血、胸闷痛、气促、发热等,临床症状与菌种间无相关性,但气促、咯血与性别具有相关性,男性更容易出现气促,而女性更容易出现咯血。NTM肺病的影像学表现中最多的是肺部结节,占90.8%;其次为支气管扩张和肺部空洞,分别占70.3%、62.7%。NTM肺病极易误诊为肺结核(68.3%)和支气管扩张(16.9%),治愈率低(34.6%)。结论NTM肺病与肺结核的临床症状及影像学表现非常相似,极易误诊。对既往有结核病史、支气管扩张、COPD、尘肺、糖尿病史及免疫力低下人群,肺部影像学表现为肺部结节、支气管扩张、空洞的患者,应高度警惕NTM肺病的可能,及时准确地进行菌种鉴定,指导临床治疗。

Objective To analyze strain distribution and clinical characteristics of non-tuberculous mycobacterial(NTM)pulmonary disease(NTM-PD)in Fuzhou City,provide reference and evidence for clinical diagnosis and treatment of NTM-PD.Methods Medical records of patients who were isolated Mycobacteria from culture of sputum or bronchoalveolar lavage fluid(BALF)specimens sent by Fuzhou Pulmonary Hospital of Fujian Province between January 2018 and January 2020 were analyzed retrospectively.Strain distribution and relevant clinical characteristics of patients with NTM-PD were analyzed.Results A total of 249 patients were confirmed with NTM-PD,10 cases(4.0%)were co-infection of NTM and Mycobacterium tuberculosis.Among 249 patients with NTM-PD,the middle-aged and elderly were more common,and women were slightly more than men.The most common pathogen was Mycobacterium intracellulare(60.6%,151 strains),followed by Mycobacterium avium(17.7%,44 strains)and Mycobacterium chelonae/Mycobacterium abscessus(17.7%,44 strains).The common susceptible factors for NTM-PD were bronchiectasis(70.3%,n=175),history of tuberculosis(28.5%,n=71),pneumoconiosis(14.5%,n=36),chronic obstructive pulmonary disease(COPD)(11.2%,n=28),history of tumor(4.8%,n=12),and diabetes mellitus(4.4%,n=11).Men were more likely to be complicated with COPD and women were more likely to be complicated with bronchiectasis.Clinical symptoms of NTM-PD were nonspecific,often manifested as cough,expectoration,hemoptysis,chest tightness and pain,shortness of breath,fever and so on,there is no correlation between clinical symptoms and species,but shortness of breath and hemoptysis were correlated with gender,men were more likely to have shortness of breath,while women were more likely to have hemoptysis.Pulmonary nodule was the most common imaging manifestation of NTM-PD,accounting for 90.8%;followed by bronchiectasis and pulmonary cavity,accounting for 70.3% and 62.7% respectively.NTM-PD was easily misdiagnosed as pulmonary tuberculosis(68.3%)and bronchiectasis(16.9%),the cure rate was low(34.6%).Conclusion Clinical symptoms and imaging manifestations of NTM-PD and pulmonary tuberculosis are very similar,which is easy to be misdiagnosed.For patients with history of tuberculosis,bronchiectasis,COPD,pneumoconiosis,diabetes mellitus and low immunity,those who are with pulmonary nodules,bronchiectasis and pulmonary cavity should be highly alert to the possibility of NTM-PD,timely and accurate identification of pathogen should be conducted to guide clinical treatment.