Kobashi Yoshihiro, Mouri Keiji, Obase Yasushi, Kato Shigeki, Oka Mikio
Department of Respiratory Medicine, Kawasaki Medical School, Japan.
Intern Med. 2013;52(22):2511-5. doi: 10.2169/internalmedicine.52.0465.
We clarified the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by pneumothorax.
We retrospectively selected 220 patients who satisfied the diagnostic criteria for NTM disease proposed by the American Thoracic Society (ATS). Nine patients with pulmonary NTM disease were complicated with pneumothorax. We investigated the patients' background, laboratory findings, radiological findings, treatment and prognoses.
There were nine patients, including six men and three women, with a mean age of 73.2 years. Seven patients had underlying respiratory diseases such as chronic obstructive pulmonary disease (COPD) excluding pulmonary NTM disease. The causative microorganisms was Mycobacterium avium in four patients, M. intracellulare in four patients, and M. kansasii in one patient. Regarding the radiological findings, pneumothorax was recognized in the right lung in five patients, in the left lung in three patients, and in both lungs heterogeneously in one patient. Although most patients exhibited multiple cavities and extensive lesions over the unilateral lung fields, three patients were simultaneously diagnosed with pulmonary NTM disease at the onset of pneumothorax. As for treatment, thoracic drainage was performed in seven patients, while one patient was advised only to rest and one patient required both thoracic drainage and surgery. The responses to the treatment was poor in each case, and five patients died due to pneumonia or heart failure.
In this study, the rate of pneumothorax complications in the patients with pulmonary NTM disease (4.1%) was higher than that of other reports. The responses to treatment, and prognoses were poor due to the presence of other complications.
明确合并气胸的肺部非结核分枝杆菌（NTM）病患者的临床特征。
我们回顾性选取了220例符合美国胸科学会（ATS）提出的NTM病诊断标准的患者。其中9例肺部NTM病患者合并气胸。我们调查了这些患者的背景、实验室检查结果、影像学检查结果、治疗及预后情况。
9例患者中，男性6例，女性3例，平均年龄73.2岁。7例患者有潜在呼吸系统疾病，如慢性阻塞性肺疾病（COPD），但不包括肺部NTM病。致病微生物为鸟分枝杆菌的有4例，胞内分枝杆菌的有4例，堪萨斯分枝杆菌的有1例。影像学检查结果显示，5例患者气胸位于右肺，3例位于左肺，1例双侧肺野均有不均匀气胸。尽管大多数患者在单侧肺野表现为多发空洞和广泛病变，但有3例患者在气胸发作时同时被诊断为肺部NTM病。治疗方面，7例患者进行了胸腔引流，1例患者仅被建议休息，1例患者既需要胸腔引流又需要手术。各病例对治疗的反应均较差，5例患者因肺炎或心力衰竭死亡。
在本研究中，肺部NTM病患者气胸并发症的发生率（4.1%）高于其他报道。由于存在其他并发症，治疗反应及预后较差。
