非结核分枝杆菌肺病和肺结核患者的临床特征分析

Analysis of clinical characteristics between patients with non-tuberculosis mycobacterial pulmonary disease and pulmonary tuberculosis

目的了解非结核分枝杆菌(NTM)肺病和肺结核的临床特征,以及NTM肺病的菌种分布。方法回顾性分析2017年5月至2020年5月在江西省人民医院住院的104例NTM肺病患者的菌种分布和临床特征,以及分析同期住院的155例肺结核患者临床特征。结果NTM肺病组年龄[(60±15)岁]高于肺结核组年龄[(55±19)岁],两组基础疾病(如恶性肿瘤、2型糖尿病、陈旧性肺结核、支气管扩张)、实验室检查(如血常规、白蛋白)、胸部影像学特征差异有统计学意义(P<0.05),临床症状(如咳嗽、咳痰、发热)差异无统计学意义(P>0.05)。NTM肺病常见基础病为恶性肿瘤(29%)、支气管扩张(21%)、慢性阻塞性肺疾病(19%)等;NTM肺病常见临床症状有咳嗽、咳痰、发热咯血、胸闷气促等非特异性呼吸道症状;NTM肺病胸部高分辨率CT(HRCT)常见表现有斑片状影(82%)、纵隔淋巴结增大(35%)、胸膜增厚(31%)、胸腔积液(26%)等征象。104例NTM肺病分离株包括鸟分枝杆菌(50%)、胞内分枝杆菌(21%)、龟/脓肿分枝杆菌(14%)、偶然分枝杆菌(5%)、戈登分枝杆菌(4%)、浅黄分枝杆菌(3%)、耻垢分枝杆菌(3%),共7种。多因素Logistic回归分析结果显示高龄(OR=1.027)是患NTM肺病的危险因素。结论NTM肺病与肺结核临床表现相似而难以鉴别,对于60岁以上男性,合并恶性肿瘤、陈旧性肺结核或支气管扩张等基础病,胸部HRCT表现以支气管扩张为主的患者,要积极排除NTM肺病。NTM肺病不同菌种之间的临床表现差异小,NTM肺病治疗周期长容易中断治疗,需要加强随访。

Objective To investigate the clinical characteristics of non-tuberculous mycobacterium(NTM)pulmonary disease and pulmonary tuberculosis,as well as the bacterial distribution of NTM pulmonary disease.Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed,as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period.Results The age of NTM lung disease group[(60±15)years]was higher than that of tuberculosis group[(55±19)years].There were statistically significant differences in basic diseases(such as malignant tumor,type 2 diabetes,old tuberculosis,bronchiectasis),laboratory examination(such as blood routine examination,albumin)and chest imaging characteristics between the two groups(P<0.05).There was no significant difference in clinical symptoms(such as cough,sputum or fever)(P>0.05).The common underlying diseases of NTM lung disease were malignant tumor(29%),bronchiectasis(21%),chronic obstructive pulmonary disease(19%),etc.The common clinical symptoms of NTM lung disease included cough,sputum,fever,hemoptysis,chest tightness and shortness of breath,and other non-specific respiratory symptoms.The common manifestations of NTM lung disease on chest high-resolution CT(HRCT)included patchy images(82%),mediastinal lymph node enalargement(35%),pleural thickening(31%),pleural effusion(26%)and other signs.The isolates of NTM included Mycobacterium avium(50%),Mycobacterium intracellulare(21%),Mycobacterium chelonae/abscessus(14%),Mycobacterium fortuitum(5%),Mycobacterium gordonae(4%),Mycobacterium gilvum(3%),and Mycobacterium smegmatis(3%).Multivariate Logistic regression analysis showed that advanced age(OR=1.027)was a risk factor for NTM lung disease.Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish.For male patients over 60 years old with malignant tumor,old tuberculosis,bronchiectasis and other basic diseases,and the chest HRCT findings are mainly bronchiectasis,NTM lung disease should be actively excluded.There is little difference in clinical manifestations between different strains of NTM lung disease,and the treatment cycle of NTM lung disease is long and easy to be interrupted,requiring enhanced follow-up.