Fowler S J, French J, Screaton N J, Foweraker J, Condliffe A, Haworth C S, Exley A R, Bilton D
Lung Defence Clinic, Cambridge, UK.
Eur Respir J. 2006 Dec;28(6):1204-10. doi: 10.1183/09031936.06.00149805. Epub 2006 Jun 28.
The aim of the current study was to investigate the prevalence and clinical associations of nontuberculous mycobacteria (NTM) in a well-characterised cohort of patients with adult-onset bronchiectasis. The sputum of all patients attending a tertiary referral bronchiectasis clinic between April 2002 and August 2003 was examined for mycobacteria as part of an extensive diagnostic work-up. NTM-positive patients subsequently had further sputa examined. A modified bronchiectasis scoring system was applied to all high-resolution computed tomography (HRCT) scans from NTM-positive patients, and a matched cohort without NTM. Out of 98 patients attending the clinic, 10 had NTM in their sputum on first culture; of those, eight provided multiple positive cultures. Three patients were treated for NTM infection. A higher proportion of NTM-positive than -negative patients were subsequently diagnosed with cystic fibrosis (two out of nine versus two out of 75). On HRCT scoring, more patients in the NTM-positive group had peripheral mucus plugging than in the NTM-negative group. In the current prospective study of a large cohort of patients with bronchiectasis, 10% cultured positive for nontuberculous mycobacteria in a random clinic sputum sample. Few clinical parameters were helpful in discriminating between groups, except for a higher prevalence of previously undiagnosed cystic fibrosis and of peripheral mucus plugging on high-resolution computed tomography in the nontuberculous mycobacteria group.
本研究的目的是调查在一组特征明确的成年期支气管扩张患者中,非结核分枝杆菌(NTM)的患病率及其临床关联。作为广泛诊断检查的一部分,对2002年4月至2003年8月期间在一家三级转诊支气管扩张诊所就诊的所有患者的痰液进行了分枝杆菌检测。NTM阳性患者随后又进行了更多痰液检测。对NTM阳性患者以及与之匹配的未感染NTM患者的所有高分辨率计算机断层扫描(HRCT)图像应用改良的支气管扩张评分系统。在诊所就诊的98例患者中,首次培养时10例痰液中发现NTM;其中8例多次培养呈阳性。3例患者接受了NTM感染治疗。NTM阳性患者中随后被诊断为囊性纤维化的比例高于NTM阴性患者(9例中有2例,而75例中有2例)。在HRCT评分中,NTM阳性组出现外周黏液嵌塞的患者比NTM阴性组更多。在本次对一大组支气管扩张患者的前瞻性研究中,随机诊所痰液样本中10%的患者非结核分枝杆菌培养呈阳性。除了在非结核分枝杆菌组中,先前未诊断出的囊性纤维化患病率较高以及高分辨率计算机断层扫描显示外周黏液嵌塞较多外,很少有临床参数有助于区分两组患者。