矽肺合并非结核分枝杆菌肺病1例

A case of silicosis complicated with non-tuberculous mycobacterium pulmonary disease

非结核分枝杆菌(NTM)是指除了结核分枝杆菌和麻风分枝杆菌以外的其他分枝杆菌, 是一种条件致病菌。NTM肺病与肺结核从临床表现到影像学表现都非常相似, 普通痰检无法准确区分结核分枝杆菌和NTM, 需要通过分枝杆菌培养基培养、高效液相色谱法、分子生物学等检测方法对其进行鉴别。1例清砂打磨工在行职业性尘肺病诊断过程中肺部CT示右肺浸润影动态改变并出现空洞, 痰药敏试验示NTM感染, 患者拒绝治疗;20个月后复查肺部CT示肺内浸润影及空洞均进一步增大, 行NTM菌种鉴定示胞内分枝杆菌感染, 给予阿米卡星、莫西沙星、阿奇霉素及乙胺丁醇联合抗菌治疗, 目前尚在治疗中。

Non-tuberculosis mycobacterium(NTM)refers to a general term for a large group of mycobacteria,excluding the mycobacterium tuberculosis and mycobacterium leprae,which is an opportunistic pathogen.NTM pulmonary disease and pulmonary tuberculosis have very similar clinical and imaging manifestations.Ordinary sputum tests can not distinguish between mycobacterium tuberculosis and NTM accurately,and it needs to be differentiated through detection methods such as mycobacterium culture medium,high-performance liquid chromatography,and molecular biology.During the diagnosis of occupational pneumoconiosis,a sandblasting and polishing worker's lung CT showed dynamic changes in infiltrating shadows and cavities in the right lung.A sputum drug sensitivity test showed NTM infection,but the patient refused treatment.After 20 months,the CT examination of the lung showed further enlargement of infiltrating shadows and cavities,and NTM bacterial identification showed intracellular mycobacterial infection.Amikacin,moxifloxacin,azithromycin,and ethambutol combined antibacterial treatment were given.Currently,the patient is still under treatment.