分枝杆菌复合群肺病中区分鸟分枝杆菌和胞内分枝杆菌的临床意义。

Clinical significance of the differentiation between Mycobacterium avium and Mycobacterium intracellulare in M avium complex lung disease.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul, South Korea.

出版信息

Chest. 2012 Dec;142(6):1482-1488. doi: 10.1378/chest.12-0494.

DOI:10.1378/chest.12-0494

PMID:22628488

Abstract

BACKGROUND

Mycobacterium avium and Mycobacterium intracellulare are grouped together as the M avium complex; however, little is known about the clinical impact of this species differentiation. This study compared the clinical features and prognoses of patients with M avium and M intracellulare lung disease.

METHODS

From 2000 to 2009, 590 patients were given a new diagnosis of M avium complex lung disease; 323 (55%) had M avium lung disease, and 267 (45%) had M intracellulare lung disease.

RESULTS

Compared with the patients with M avium lung disease, the patients with M intracellulare lung disease were more likely to have the following characteristics: older age (64 vs 59 years, P = .002), a lower BMI (19.5 kg/m² vs 20.6 kg/m², P < .001), respiratory symptoms such as cough (84% vs 74%, P = .005), a history of previous treatment for TB (51% vs 31%, P < .001), the fibrocavitary form of the disease (26% vs 13%, P < .001), smear-positive sputum (56% vs 38%, P < .001), antibiotic therapy during the 24 months of follow-up (58% vs 42%, P < .001), and an unfavorable microbiologic response after combination antibiotic treatment (56% vs 74%, P = .001).

CONCLUSIONS

Patients with M intracellulare lung disease exhibited a more severe presentation and had a worse prognosis than patients with M avium lung disease in terms of disease progression and treatment response. Therefore, species differentiation between M avium and M intracellulare may have prognostic and therapeutic implications.

摘要

背景

鸟分枝杆菌和胞内分枝杆菌被归为鸟分枝杆菌复合群；然而，对于这种种系分化的临床影响知之甚少。本研究比较了鸟分枝杆菌复合群肺病患者的临床特征和预后。

方法

2000 年至 2009 年，590 例患者被新诊断为鸟分枝杆菌复合群肺病；323 例（55%）患有鸟分枝杆菌肺病，267 例（45%）患有胞内分枝杆菌肺病。

结果

与鸟分枝杆菌肺病患者相比，胞内分枝杆菌肺病患者更可能具有以下特征：年龄较大（64 岁 vs 59 岁，P=0.002），BMI 较低（19.5kg/m² vs 20.6kg/m²，P<0.001），咳嗽等呼吸道症状（84% vs 74%，P=0.005），既往结核病治疗史（51% vs 31%，P<0.001），纤维空洞型病变（26% vs 13%，P<0.001），痰涂片阳性（56% vs 38%，P<0.001），随访 24 个月期间接受抗生素治疗（58% vs 42%，P<0.001），联合抗生素治疗后微生物学反应不佳（56% vs 74%，P=0.001）。