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台湾地区非结核分枝杆菌肺病的临床病理特征。

Clinicopathologic characteristics of nontuberculous mycobacterial lung disease in Taiwan.

机构信息

Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

Diagn Microbiol Infect Dis. 2010 Nov;68(3):228-35. doi: 10.1016/j.diagmicrobio.2010.06.008. Epub 2010 Sep 16.

Abstract

Taiwan is an endemic area for tuberculosis (TB), and the incidence of pulmonary infection caused by nontuberculous mycobacteria (NTMs) is also increasing. This study aims to investigate the clinicopathologic characteristics of patients with NTM lung disease during 1998 to 2007 at a medical center in Taiwan. The medical records of patients with confirmed NTM pulmonary infections who underwent open lung surgery in a medical center were reviewed. Twenty-four patients with confirmed NTM pulmonary infections were identified. These patients were histologically classified into 4 types: fibrocavitary/tuberculoid (n = 10), nodular bronchiectatic (n = 4), sarcoidal (n = 6), and other (n = 4). The fibrocavitary/tuberculoid type usually (90%) develops in the upper lobes of old patients with preexisting lung disease. Pulmonary TB (n = 7, 70%) was the major underlying disease before 2003. Nodular bronchiectatic type occurred mainly in the middle lobe of middle-aged women without preexisting lung disease. Sarcoidal type was usually associated with Mycobacterium avium complex infection and develops in middle-aged women. Immunoreactive bacilli were detected in 21 patients (87 %) by immunohistochemical staining using a polyclonal antibody against Mycobacterium tuberculosis and other mycobacterial species (M. avium-intracellulare, Mycobacterium phlei, and Mycobacterium parafortuitum), whereas conventional acid-fast staining was positive in only 21% of patients. In conclusion, TB was the major underlying disease in patients with NTM lung disease in Taiwan. The different histologic types of pulmonary NTM infection suggest each had a distinct pathogenesis.

摘要

台湾是结核病(TB)的流行地区,非结核分枝杆菌(NTM)引起的肺部感染的发病率也在增加。本研究旨在探讨 1998 年至 2007 年期间在台湾一家医学中心就诊的 NTM 肺部疾病患者的临床病理特征。回顾了在一家医学中心接受开胸手术确诊为 NTM 肺部感染者的患者病历。共确定了 24 例确诊为 NTM 肺部感染的患者。这些患者的组织病理学分类为 4 种类型:纤维空洞/结核样型(n = 10)、结节性支气管扩张型(n = 4)、类肉瘤型(n = 6)和其他型(n = 4)。纤维空洞/结核样型通常(90%)发生在伴有先前肺部疾病的老年患者的上叶。肺结核(n = 7,70%)是 2003 年前的主要基础疾病。结节性支气管扩张型主要发生在无先前肺部疾病的中年女性的中叶。类肉瘤型通常与鸟分枝杆菌复合体感染有关,发生在中年女性中。用针对结核分枝杆菌和其他分枝杆菌(鸟分枝杆菌-胞内分枝杆菌、草分枝杆菌和偶然分枝杆菌)的多克隆抗体进行免疫组织化学染色,在 21 例患者(87%)中检测到免疫反应性杆菌,而常规抗酸染色仅在 21%的患者中阳性。总之,TB 是台湾 NTM 肺部疾病患者的主要基础疾病。肺部 NTM 感染的不同组织学类型表明每种类型都有不同的发病机制。

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