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[相对罕见的非结核分枝杆菌肺病的治疗]

[Treatment of relatively rare species nontuberculous pulmonary mycobacteriosis].

作者信息

Kurashima Atsuyuki

机构信息

Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan.

出版信息

Kekkaku. 2011 Dec;86(12):923-32.

Abstract

Today, a treatment guide of relatively rare species nontuberculous mycobacteriosis (NTM) is required ever-increasing. Because, new species are discovered continuously with advanced nucleic identification technique and these results entered routine clinical practice. Secondly, under the influence of newly introduced bioactive drugs for treatment of RA, rare species NTM cases has been really increased. And although there have been over 150 species NTM, the right chemotherapy regimen is not uniform like as TB treatment, it should only rely on accumulated clinical experiences for each species respectively. Case series of relatively rare species NTM are rare enough in itself at a global level, therefor the treatment is also less evidence. However, the following two may be written definitely recommended. M. szulgai pulmonary disease chemotherapy is recommended with RFP, INH, EB chemotherapy includes 12 months of negative sputum cultures. M. fortuitum pulmonary disease should be given at least more than two sensitive drugs including new quinolone for to reach 12 months of negative sputum cultures. For other species, chemotherapy regimen and duration of treatment has not been established. In case of unspecified or unknown species mycobacteriosis, the chemotherapy regimen should be suggested the treatment of in relatively same group on Runyon classification.

摘要

如今,对于相对罕见的非结核分枝杆菌病(NTM)的治疗指南需求日益增加。原因在于,随着先进的核酸鉴定技术不断发现新的菌种,且这些成果已进入常规临床实践。其次,在新引入的用于治疗类风湿关节炎的生物活性药物的影响下,罕见菌种NTM病例确实有所增加。尽管已发现超过150种NTM菌种,但与结核病治疗不同,正确的化疗方案并不统一,只能分别依据每种菌种积累的临床经验来制定。相对罕见菌种NTM的病例系列在全球范围内本身就极为罕见,因此相关治疗的证据也较少。然而,以下两点可以明确推荐。对于堪萨斯分枝杆菌肺病,建议采用利福平(RFP)、异烟肼(INH)、乙胺丁醇(EB)化疗,疗程包括12个月痰培养转阴。对于偶然分枝杆菌肺病,应至少给予两种敏感药物,包括新型喹诺酮类药物,直至痰培养转阴达12个月。对于其他菌种,化疗方案和治疗疗程尚未确定。对于未明确或未知菌种的分枝杆菌病,化疗方案应建议按照Runyon分类中相对同类的情况进行治疗。

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