摘要目的 分析脓肿分枝杆菌群肺病的临床表现和对含头孢西丁治疗方案的疗效.方法 回顾性分析北京胸科医院新诊断的脓肿分枝杆菌群肺病16例的临床表现,以及全疗程克拉霉素和莫西沙星口服治疗,前12周增加头孢西丁和阿米卡星静脉滴注的强化治疗方案的疗效.结果 16例脓肿分枝杆菌群肺病患者中有14例为结节支气管扩张型,1例为上叶空洞型,1例为未分类型；影像学特点表现为多发微结节(14/16)、支气管扩张(14/16)、树芽征(13/16)、空洞(5/16)、肺实变(5/16)、结节(5/16)和肺体积缩小(3/16).5例采用含头孢西丁的强化治疗方案3个月,其中2例症状和影像学表现改善,痰分枝杆菌培养转阴；2例症状和影像学表现改善,但痰分枝杆菌未转阴；1例的症状、影像学表现和痰分枝杆菌培养均未改善,经后续的巩固治疗也未见改善.结论 脓肿分枝杆菌群肺病主要表现为结节支气管扩张型,以多发微结节、树芽征和支气管扩张为主要影像学表现,含头孢西丁的抗生素联合治疗方案对患者有一定疗效.

abstractsObjective To analyze the clinical manifestations and efficacy of a combination antibiotic therapy including cefoxitin for Mycobacterium abscessus (M.abscessus) group lung disease.Methods We retrospectively analyzed the clinical manifestations of 16 patients with M.abscessus group lung disease,and the responses of 5 cases treated with whole-course clarithromycin and moxifloxacin,initially intensified with intravenous amikacin and cefoxitin therapy for the first 12 weeks.Results Radiological study showed that 14 patients with M.abscessus group pulmonary disease were classified as nodular bronchiectasis form,and 1 patient as upper lobe cavity form and 1 patient was unclassifiable.The radiological characteristics of M.abscessus group pulmonary disease included multiple micronodules (14/16),bronchiectasis (14/16),tree in bud sign (13/16),cavity (5/16),consolidation (5/16),nodules (5/16),and collapse of lung (3/16).Five cases were treated with a combination antibiotic therapy including cefoxitin.After 3 months treatment for the initial phase,2 of them got improvement in symptoms,CT manifestations and sputum conversion.Two of them improved in symptoms and CT manifestations,but not in sputum conversion.One case showed no improvement in the initial phase,and continuation therapy also failed to improve symptoms,CT abnormalities or sputum conversion.Conclusions Nodular bronchiectasis is the main manifestation of M.abscessus group lung disease.The main imaging characteristics included multiple micronodules,bronchiectasis and tree in bud sign.A therapeutic regimen including cefoxitin may be moderately effective in treating M.abscessus group lung disease.