102例非结核分枝杆菌感染临床和CT影像学特征

Clinical features and CT imaging characteristics of 102 patients with nontuberculous Mycobacteria infection

目的 分析102例非结核分枝杆菌(NTM)感染临床特征和炎性指标变化及CT影像学表现。方法 选取2018年7月-2020年12月深圳市第三人民医院、深圳市龙岗区人民医院收治的疑似肺结核患者568例,分析胸腔积液标本NTM分离情况,观察NTM患者胸部CT影像表现,硝基苯甲酸和噻吩-2-羧酸肼法鉴定菌型,基因芯片法鉴定NTM菌种。分析炎症指标C-反应蛋白(CRP)、白细胞计数、血沉水平差异。结果 568例患者共检出102例非结核分枝杆菌肺病(NTM-PD)患者;NTM-PD患者主要检出脓肿分枝杆菌52株占50.98%、其次为胞内分枝杆菌24株占23.53%;患者既往患有结核病史(57.84%)和支气管扩张(22.55%);患者出现咳嗽咳痰症状最多(75.49%);患者胸部影像学表现最多的是类支气管扩张(36.27%);其次是肺部空洞(35.29%)和结节(34.31%)。脓肿分枝杆菌感染肺病患者白细胞计数高于胞内分枝杆菌和鸟分枝杆菌感染肺病患者(P<0.05)。胞内分枝杆菌感染患者CRP水平高于脓肿分枝杆菌和鸟分枝杆菌感染肺病患者(P<0.05),血沉低于脓肿分枝杆菌和鸟分枝杆菌感染肺病患者(P<0.05)。结论 NTM-PD与MTB肺病患者临床特征和CT影像具有一定差异性和相似性,临床诊断两者可结合患者临床特征及CT影像学综合鉴别。

OBJECTIVE To investigate the clinical characteristics,changes of inflammatory factors and CT imaging findings of 102 patients with nontuberculous Mycobacteria(NTM) infection.METHODS A total of 568 patients with suspected tuberculosis who were treated in Shenzhen Third People′s Hospital and Shenzhen Longgang District People′s Hospital from Jul 2018 to Dec 2020 were enrolled in the study,the species of NTM isolated from pleural effusion specimens were identified,the chest CT imaging findings of the patients with NTM infection were observed,the species were identified by nitrobenzoic acid and thiophene-2-carboxyhydrazine method.The levels of inflammatory indexes C-reactive protein(CRP),white blood cell and erythrocyte sedimentation rate(ESR) were analyzed.RESULTS Totally 102 patients were identified with NTM-PD among the 568 patients.Among the species of NTM isolated from the patients with NTM-PD,there were 52(50.98%) strains of Mycobacteria abscess and 24(23.53%) strains of Mycobacteria intracellulare.57.84% of the patients had the previous history of tuberculosis,and 22.55% had bronchiectasis;75.49% of the patients had cough and expectoration.In terms of the chest imaging findings,36.27% of the patients had bronchiectasis,35.29% had lung cavity,and 34.31% had nodules.The white blood cell counts of the patients with M.abscess infection was significantly greater than that of the patients with M.intracellulare infection and the patients with M.avium infection(P<0.05).The CRP level of the patients with M.intracellulare infection was significantly higher than that of the patients with M.abscess infection and the patients with M.avium infection(P<0.05),and the ESR of the patients with M.intracellulare infection was significantly lower than that of the patients with M.abscess infection and the patients with M.avium infection(P<0.05).CONCLUSION The clinical characteristics and CT imaging findings of the NTM-PD patients show certain difference and similarity with the MTB lung disease patients,and the clinical differential diagnosis of the two types of patients can be performed based on the clinical characteristics combined with CT imaging.