New York University School of Medicine, New York, NY, USA.
Curr Opin Pulm Med. 2018 May;24(3):212-219. doi: 10.1097/MCP.0000000000000473.
To highlight recent original research and specialty society guidelines regarding the diagnosis and treatment of nontuberculous mycobacterial (NTM) pulmonary disease.
The prevalence of NTM pulmonary disease has risen in recent years. The prevalence of individual NTM species varies geographically, although Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC) remain among the most commonly encountered in many regions. Diagnosis and treatment of NTM pulmonary disease can be complex but guideline-based recommendations have been published. However, adherence to guideline recommendations is poor. Drug susceptibility testing plays a role with important caveats for treatment. Alternative therapies are being explored with older antimycobacterial drugs like clofazimine, which has demonstrated efficacy and tolerability for treatment-refractory NTM infections, and a novel formulation of amikacin for inhalation which may be better tolerated than parenteral administration. Several studies have shown that patients will have recurrences as high as 48%, and that these are not solely relapses but many cases are reinfections with a new organism. United States and European research registries of patients with non-cystic fibrosis bronchiectasis are expected to provide needed data on clinical characteristics of patients at risk for NTM pulmonary disease.
The evidence base for optimal management of NTM pulmonary disease is expanding but notable gaps in the literature remain.
强调最近关于非结核分枝杆菌（NTM）肺部疾病的诊断和治疗的原始研究和专业学会指南。
近年来，NTM 肺部疾病的患病率有所上升。虽然在许多地区，鸟分枝杆菌复合体（MAC）和脓肿分枝杆菌复合体（MABC）仍然是最常见的，但个别 NTM 物种的流行情况因地理位置而异。NTM 肺部疾病的诊断和治疗可能很复杂，但已发布了基于指南的建议。然而，对指南建议的依从性很差。药敏试验在治疗方面具有重要的注意事项。正在探索替代疗法，如氯法齐明，它对治疗耐药性 NTM 感染具有疗效和耐受性，以及一种新型阿米卡星吸入制剂，其耐受性可能优于静脉给药。几项研究表明，患者的复发率高达 48%，而且这些复发不仅是单纯的复发，许多情况下是新病原体的再感染。美国和欧洲的非囊性纤维化支气管扩张症患者研究登记处预计将提供有关有 NTM 肺部疾病风险的患者临床特征的所需数据。
NTM 肺部疾病最佳管理的证据基础正在扩大，但文献中仍存在明显的差距。
