摘要目的 探讨常见分枝杆菌肺病的临床特征及药敏试验结果.方法 回顾性分析上海市肺科医院结核科2014年3月至2015年3月确诊且有菌种鉴定结果的非结核分枝杆菌肺病(NTMPD)患者201例,其中男108例,女93例,年龄23～87岁,平均(58±15)岁.堪萨斯分枝杆菌肺病(堪萨斯组)48例,男46例,女2例,年龄25～81岁,平均(52±16)岁;脓肿分枝杆菌肺病(脓肿组)46例,男13例,女33例,年龄23～86岁,平均(57±16)岁;胞内分枝杆菌肺病(胞内组)92例,男43例,女49例,年龄27～85岁,平均(61±13)岁;鸟分枝杆菌肺病(鸟组)15例,男6例,女9例,年龄44～87岁,平均(67±10)岁.收集确诊时不同菌种组患者的症状、实验室检查、影像学特征及药敏试验等资料,采用卡方检验对4组患者进行对比,两两对比采用Bonferroni法.结果 人口学资料比较:年龄(x2=6.42,P＜0.001)和性别(x2=49.18,均P＜0.001)比较差异有统计学意义;既往病史对比:堪萨斯组、脓肿组、胞内组及鸟组的支气管扩张病史分别为2/48、31/46、39/92和4/15例,组间比较差异有统计学意义(x2=41.84,均P＜0.001);γ-干扰素释放试验(IGRA)对比:堪萨斯组、脓肿组、胞内组及鸟组的阳性率分别为83％(40/48)、30％(14/46)、23％(21/92)和33％(5/15),组间比较差异有统计学意义(x2=50.96,均P＜0.001);影像学表现:堪萨斯组、脓肿组、胞内组及鸟组的树芽征(8/48、35/46、36/92和4/15例,x2=36.48,均P＜0.001)、合并胸膜改变(21/48、36/46、69/92和7/15例,x2=19.54,均P＜0.001)、合并支气管扩张(20/48、39/46、78/92和10/15例,均P＜0.001)和肺内空洞影(38/48、21/46、63/92和10/15例,x2=12.38,均P＜0.001)等比较差异均有统计学意义;药敏试验结果:堪萨斯组对利福平、乙胺丁醇及氧氟沙星的耐药率分别为10％(5/48)、8％(4/48)和15％(7/48),胞内组对乙胺丁醇的耐药率为45％(41/92),脓肿分枝杆菌对抗结核药物的耐药率均为80％以上;两两对比的结果显示,堪萨斯分枝杆菌患者的男性比例(46/48)、IGRA阳性率(40/48)高于其他组,合并支气管扩张(20/48)、胸膜改变(21/48)的发生率低于其他组;脓肿分枝杆菌患者的女性比例(33/46)、合并支气管扩张史(31/46)、树芽征的发生率(35/46)高于其他组.结论 4种常见非结核分枝杆菌肺病患者在临床表现和影像学特征上有一定的差异.堪萨斯分枝杆菌患者以男性为主、IGRA阳性率高,病灶较少有支气管扩张或胸膜改变.脓肿分枝杆菌患者以女性为主,既往多合并支气管扩张史,病灶以树芽征多见.除堪萨斯分枝杆菌以外,其他3种NTM菌对抗结核药物均具有较高的耐药率.

abstractsObjective To investigate the clinical characteristics and drug susceptibility test (DST) of patients infected with different nontuberculous mycobacteria (NTM).Methods The patients with nontuberculous mycobacterial lung disease (NMLD) in Shanghai Pulmonary Hospital from March 2014 to March 2015 were studied retrospectively by analyzing the clinical characteristics,radiological features and DST results.A total of 201 NMLD patients [male 108,age(58±15) yrs] were enrolled into this study including 48 cases ofM.Kansasii [male 13,age (52±16) yrs],46 cases of M.Abscess[male 46,age (57±16) yrs],92 cases ofM.Intracellulare [male 43,age (61±13) yrs],and 15 cases ofM.Avium [male 6,age (67±10) yrs].Clinical data were collected when the diagnosis was made and Chi-square test was used to compare the differences among 4 groups of patients.Bonferroni method was used for further pairwise comparisons.Results There were significant differences among the 4 groups in the age(x2=6.42,P＜0.001)and the gender(x2=49.18,P＜ 0.001)of the patients.The history of bronchiectasis in the groups of M.Kansasii,M.Abscess,M.Intracellulare and M.Avium were 2 / 48,31 / 46,39 / 92 and 4 / 15 cases respectively(x2 =41.84,P＜0.001).For the Gamma-interferon release assays (ELISA) (IGRA),the positive rate of IGRA in the groups of M.Kansasii,M.Abscess,M.Intracellulare and M.Avium were 83％(40/48),30％(14/46),23％(21/92) and 33％ (5/15) respectively(x2=50.96,P＜0.001).The radiological features were significantly different in tree-in-bud(8/48,35/46,36/92 and 4/15 cases respectively,x2=36.48,P＜0.001),pleural thickness or mild effusion (21/48,36/46,69/92 and 7/15 cases,x2=19.54,P＜0.001),bronchiectasis (20/48,39/46,78/92 and 10/15 cases,P＜ 0.001)and cavities(38/48,21/46,63/92 and 10/15 cases,x2=12.38,P＜0.001) among the 4 groups(M.Kansasii,M.Abscess,M.lntracellulare and M.Avium).The drug resistance rates of M.Kansasii to rifampin,ethambutanol and ofloxacin were 10％(5/48),8％(4/48) and 15％(7/48) respectively;the resistance rates of M.Intracellulare to ethambutanol was 45％(41/92),and the resistance rates of M.Abscess were all over 80％ to all anti-TB drugs.The results of pairwise comparisons showed that the male proportion(46/48) and IGRAs positive rate(40/48) of patients with M.Kansasii were higher than those of other groups,and the incidence of bronchiectasis(20/48) and pleural changes(21/48) was lower than those of other groups.The female ratio(33/46),history of bronchiectasis (31/46) and tree-in-bud sign of patients(35/46) with M.Abscess were higher than those of other groups.Conclusions There were differences in the clinical manifestations and imaging features of 4 common NMLD diseases,which were helpful for clinical differentiation.The patients with M.Kansasii infection were mainly male,with a high IGRA positive rate and fewer lesions of bronchiectasis or pleural changes.Most of the patients with M.Abscess were female,with a previous history of bronchiectasis,and with most of the lesions showing tree-in-bud signs.The NTM species had a high rate of resistance to anti-TB drugs except M.Kansasii.