Kurashima Atsuyuki
Clinical Research Division, National Tokyo Hospital, 3-1-1, Takeoka, Kiyoseshi, Tokyo 204-8585, Japan.
Kekkaku. 2002 Dec;77(12):815-21.
Pulmonary non-tuberculous mycobacteriosis in Japan occurs more than about 5,000 cases annually. Among them, about 70% are occupied by Mycobacterium avium complex (MAC) infection. Considering the frequency and the difficulty of treatment, we discuss mainly on pulmonary MAC infection on this report. At National Tokyo hospital, secondary MAC infection after tuberculosis sequelae were 46.5% out of 170 pulmonary MAC cases since 1969 to 1985, but it decreased to 19.4% out of 268 cases since 1986 to 2000. In this same period, a type of MAC infection like middle lobe syndrome without recognizing preceding pulmonary disease, increased to 69.8% out of all pulmonary MAC cases (Fig. 1). Recently, this type of pulmonary MAC infection, which consists with scattered nodular lesion and local bronchiectasis in middle lobe or lingula, attracts attention. Why is there much frequency in women? Why does it originate from middle lobe or lingula? Although, it shows a characteristic X-ray pattern, ant it is still an interesting problem, the origin of the disease cannot be clarified. First diagnostic standard of nontuberculous mycobacteriosis in Japan was submitted in 1967, and the current diagnostic standard was made in 1985, through several times improvements. These contents are almost similar to that of American diagnostic standard in 1997, but the new revision that reflected chest CT findings and bronchoscopic sampling etc, is pressed now. In the treatment, INH or PZA, which is a key drug in tuberculous chemotherapy, is not a key drug in MAC chemotherapy. MAC chemotherapy is multidrugs combination chemotherapy including EB, CAM, RFP, and aminoglycosides. However, it is difficult to achieve complete regression with current drugs combinations, and an early surgical resection is the most effective in case of localized MAC lesion. We propose a guidance of treatment selection with age and disease severity (Table). Fig. 2 shows survival curves of 104 cases pulmonary MAC infection at National Tokyo Hospital.
日本每年发生的非结核分枝杆菌肺病超过5000例。其中，约70%为鸟分枝杆菌复合群（MAC）感染。考虑到发病频率和治疗难度，本报告主要讨论肺部MAC感染。在东京国立医院，1969年至1985年期间，170例肺部MAC病例中，结核后遗症继发的MAC感染占46.5%，但1986年至2000年期间，268例病例中该比例降至19.4%。在同一时期，一种未发现先前肺部疾病的MAC感染类型，如中叶综合征，在所有肺部MAC病例中增加到69.8%（图1）。最近，这种以中叶或舌叶散在结节性病变和局部支气管扩张为特征的肺部MAC感染引起了关注。为什么女性发病率高？为什么它起源于中叶或舌叶？尽管它显示出特征性的X线表现，但疾病的起源仍不清楚，这仍是一个有趣的问题。日本非结核分枝杆菌病的首个诊断标准于1967年提出，现行诊断标准于1985年经过多次改进后制定。这些内容与1997年美国诊断标准几乎相似，但目前迫切需要反映胸部CT表现和支气管镜采样等的新修订版。在治疗方面，结核化疗中的关键药物异烟肼或吡嗪酰胺，在MAC化疗中并非关键药物。MAC化疗是包括乙胺丁醇、卷曲霉素、利福平及氨基糖苷类药物的多药联合化疗。然而，目前的药物组合难以实现完全缓解，对于局限性MAC病变，早期手术切除最为有效。我们提出了根据年龄和疾病严重程度选择治疗方法的指南（表）。图2显示了东京国立医院104例肺部MAC感染患者的生存曲线。
