痰涂片抗酸杆菌阳性患者中非结核分枝杆菌肺病与肺结核的特征：一项回顾性比较研究。
Characterization of non-tuberculous mycobacterial pulmonary disease and pulmonary tuberculosis in patients with AFB smear-positive sputum: A retrospective comparative study.
作者信息
Li Xiaoming, Sun Dezhi, Liang Changsheng, Gu Wen
机构信息
Department of Respiratory and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665, Kongjiang Road, Shanghai, 200092, China.
Department of Respiratory and Critical Care Medicine, Weifang Respiratory Disease Hospital, Weifang NO. 2 People's Hospital, 7, Yuanxiao Street, Weifang, 261041, Shandong Province, China.
出版信息
Heliyon. 2024 Sep 4;10(17):e37434. doi: 10.1016/j.heliyon.2024.e37434. eCollection 2024 Sep 15.
BACKGROUND
Distinguishing nontuberculous mycobacteria pulmonary disease (NTM-PD) from pulmonary tuberculosis (PTB) is a challenge especially in patients with positive sputum smear of acid-fast bacilli (AFB). This study aimed to compare and identify the clinical characteristics between the two diseases among patients with positive sputum AFB.
METHODS
From February 2017 through March 2021, patients with positive sputum AFB were reviewed in two hospitals of China. Among them, clinical data of NTM-PD and PTB patients was collected and compared.
RESULTS
76 cases of NTM-PD and 92 cases of PTB were included in our study. When compared with PTB, NTM-PD patients were older (59.2 ± 11.4 vs 44.2 ± 19.5 years, P < 0.001) and manifested more hemoptysis and dyspnea (28.9 % vs 14.1 %, P < 0.05; 48.7 % vs 17.4 %, P < 0.001 respectively). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for Xpert were 85.9 %, 96.1 %, 96.3 %, 84.9 %, respectively, compared to 94.2 %, 81.1 %, 83.1 %, 93.5 %, respectively for T-spot in diagnosing PTB. In radiological features, NTM-PD affected more lobes (4.53 ± 0.89 vs 3.61 ± 1.41, P < 0.001) and showed more consolidation (50 % vs 32.6 %, P < 0.05), destroyed lung (22.7 % vs 9.8 %, P < 0.05), honeycomb lung (26.7 % vs 6.5 %, P < 0.001) but less nodules (80.3 % vs 95.7 %, P < 0.05), tree-in-bud sign (49.3 % vs 87 %, P < 0.001), and satellite nodules (14.5 % vs 90.2 %, P < 0.001) than PTB. Age (odds ratio [OR], 1.043; 95 % confidence interval [CI], 1.018-1.069, P < 0.05), hemoptysis (OR, 3.552; 95%CI, 1.421-8.729, P < 0.05), and dyspnea (OR, 2.631; 95%CI, 1.151-6.016, P < 0.05) were independently correlated with NTM infection.
CONCLUSIONS
NTM-PD and PTB share similar clinical manifestations. Among them, advanced age, hemoptysis, and dyspnea are the independent predictors for NTM infection. Xpert is an efficiency analysis in discriminating between NTM-PD and PTB in patients with positive sputum AFB.
背景
区分非结核分枝杆菌肺病（NTM-PD）和肺结核（PTB）具有挑战性，尤其是对于痰涂片抗酸杆菌（AFB）阳性的患者。本研究旨在比较并识别痰AFB阳性患者中这两种疾病的临床特征。
方法
2017年2月至2021年3月，对中国两家医院痰AFB阳性的患者进行了回顾性研究。收集并比较了其中NTM-PD和PTB患者的临床资料。
结果
本研究纳入了76例NTM-PD患者和92例PTB患者。与PTB相比，NTM-PD患者年龄更大（59.2±11.4岁 vs 44.2±19.5岁，P<0.001），咯血和呼吸困难表现更常见（分别为28.9% vs 14.1%，P<0.05；48.7% vs 17.4%，P<0.001）。Xpert诊断PTB的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）分别为85.9%、96.1%、96.3%、84.9%，而T-spot的相应值分别为94.2%、81.1%、83.1%、93.5%。在影像学特征方面，NTM-PD累及的肺叶更多（4.53±0.89 vs 3.61±1.41，P<0.001），实变更多（50% vs 32.6%，P<0.05），肺毁损更多（22.7% vs 9.8%，P<0.05），蜂窝肺更多（26.7% vs 6.5%，P<0.001），但结节更少（80.3% vs 95.7%，P<0.05），树芽征更少（49.3% vs 87%，P<0.001），卫星结节更少（14.5% vs 90.2%，P<0.001）。年龄（比值比[OR]，1.043；95%置信区间[CI]，1.018 - 1.069，P<0.05）、咯血（OR，3.552；95%CI，1.421 - 8.729，P<0.05）和呼吸困难（OR，2.631；95%CI，1.151 - 6.016，P<0.05）与NTM感染独立相关。
结论
NTM-PD和PTB有相似的临床表现。其中，高龄、咯血和呼吸困难是NTM感染的独立预测因素。Xpert在鉴别痰AFB阳性患者的NTM-PD和PTB方面是一种有效的分析方法。
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