Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul, South Korea.
Chest. 2012 Dec;142(6):1482-1488. doi: 10.1378/chest.12-0494.
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.
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.
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).
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.
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。
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。
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）。
胞内分枝杆菌肺病患者在疾病进展和治疗反应方面表现出更严重的临床表现和更差的预后，与鸟分枝杆菌肺病患者相比。因此，鸟分枝杆菌和胞内分枝杆菌的种系分化可能具有预后和治疗意义。
