Szturmowicz Monika, Oniszh Karina, Wyrostkiewicz Dorota, Radwan-Rohrenschef Piotr, Filipczak Dorota, Zabost Anna
Ist Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Płocka 26, 01-138 Warsaw, Poland.
Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Płocka 26, 01-138 Warsaw, Poland.
Antibiotics (Basel). 2020 Jul 20;9(7):424. doi: 10.3390/antibiotics9070424.
Non-tuberculous mycobacteria (NTM) are increasingly a cause of human respiratory tract colonization and mycobacterial lung disease (NTM-LD), especially in patients with chronic lung diseases. The aim of the present study was to find the factors predictive of NTM-LD in patients with obstructive lung diseases and NTM respiratory isolates. A total of 839 isolates of NTM, obtained from 161 patients between 2010 and 2020 in a single pulmonary unit, have been retrospectively reviewed. Of these isolates, 73 concerned 36 patients with obstructive lung diseases (COPD-26, asthma-3, COPD/asthma overlap syndrome-7). NTM-LD was recognized according to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) criteria in 17 patients, colonization in 19. Lower BMI, elevated body temperature on admission, infiltrative/cavitary lesions on chest CT, and NTM species other than were the significant predictors of NTM-LD recognition. Based on the above-mentioned predictive factors, an original scoring system was implemented. The diagnostic utility of the scoring system was higher than that of single parameters. We conclude that NTM-LD prediction in patients with obstructive lung diseases and positive respiratory isolates is difficult. A scoring system based on clinical, radiological and microbiological characteristics was capable of facilitating the differential diagnosis, but it needs further validation in a larger study group.
非结核分枝杆菌（NTM）越来越多地成为人类呼吸道定植和分枝杆菌肺病（NTM-LD）的病因，尤其是在慢性肺病患者中。本研究的目的是找出阻塞性肺病患者和NTM呼吸道分离株中NTM-LD的预测因素。对2010年至2020年间在单个肺科病房从161例患者中获得的总共839株NTM分离株进行了回顾性分析。在这些分离株中，73株涉及36例阻塞性肺病患者（慢性阻塞性肺疾病-26例、哮喘-3例、慢性阻塞性肺疾病/哮喘重叠综合征-7例）。根据美国胸科学会（ATS）和美国感染病学会（IDSA）的标准，17例患者被诊断为NTM-LD，19例为定植。较低的体重指数、入院时体温升高、胸部CT上的浸润性/空洞性病变以及 以外的NTM菌种是NTM-LD诊断的重要预测因素。基于上述预测因素，实施了一个原创的评分系统。该评分系统的诊断效用高于单一参数。我们得出结论，阻塞性肺病患者且呼吸道分离株呈阳性时，预测NTM-LD很困难。基于临床、放射学和微生物学特征的评分系统能够促进鉴别诊断，但需要在更大的研究组中进一步验证。
