Kobashi Yoshihiro, Matsushima Toshiharu
Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki.
Intern Med. 2003 Aug;42(8):670-5. doi: 10.2169/internalmedicine.42.670.
To investigate whether the combined therapy according to the guideline proposed by American Thoracic Society (ATS) and Japanese Society for Tuberculosis (JST) is clinically appropriate for Mycobacterium avium complex (MAC) pulmonary disease.
Seventy-one patients in whom MAC pulmonary disease was diagnosed at Kawasaki Medical School and our associated ten hospitals were prospectively studied.
Seventy-one patients with Mycobacterium avium complex (MAC) pulmonary disease were 27 males and 44 females with a mean age of 64.4 +/- 10.2 years old. Patients received 400 mg/day or 600 mg/day of clarithromycin plus ethambutol, rifampicin, and initial streptomycin for 12 months. Among 71 patients who received more than 12 months of therapy, 41 patients (57.7%) converted their sputum to negative within six months after the initiation of this regimen, 16 of 41 patients (39.0%) relapsed, and 23 of 71 patients (32.4%) obtained clinical improvement on chest X-ray and/or clinical symptoms. The mortality rate had a comparatively good prognosis with a low incidence of 2.8%. Although the species of pathogen (M. avium or M. intracellulare) did not significantly affect the conversion rate or clinical improvement, the infectious form with or without respiratory underlying disease, the characteristics and extent of lesion on chest X-ray, and the dose of clarithromycin significantly influenced the conversion rate or clinical improvement. There were no problems concerning adverse reactions for this regimen.
This combined therapy, according to the guideline proposed by ATS and JST, was one of the effective treatments compared to the clinical effect of only antituberculous drugs through this study. However, this combined therapy was unsatisfactory compared to the clinical effect for pulmonary tuberculosis. The development of new companion drugs for MAC pulmonary diseases is needed.
探讨按照美国胸科学会（ATS）和日本结核病学会（JST）提出的指南进行联合治疗对鸟分枝杆菌复合群（MAC）肺病是否具有临床适用性。
对在川崎医科大学及其附属的十家医院被诊断为MAC肺病的71例患者进行前瞻性研究。
71例鸟分枝杆菌复合群（MAC）肺病患者中，男性27例，女性44例，平均年龄64.4±10.2岁。患者接受每日400mg或600mg克拉霉素联合乙胺丁醇、利福平，并初始使用链霉素治疗12个月。在接受超过12个月治疗的71例患者中，41例（57.7%）在该治疗方案开始后6个月内痰菌转阴，41例中的16例（39.0%）复发，71例中的23例（32.4%）胸部X线和/或临床症状获得改善。死亡率较低，预后相对较好，发生率为2.8%。尽管病原体种类（鸟分枝杆菌或胞内分枝杆菌）对转阴率或临床改善无显著影响，但有无呼吸道基础疾病的感染形式、胸部X线病变的特征和范围以及克拉霉素剂量对转阴率或临床改善有显著影响。该治疗方案的不良反应方面没有问题。
通过本研究，与仅使用抗结核药物的临床效果相比，按照ATS和JST提出的指南进行的这种联合治疗是有效的治疗方法之一。然而，与肺结核的临床效果相比，这种联合治疗并不令人满意。需要开发用于MAC肺病的新型辅助药物。
