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高结核病负担背景下非结核分枝杆菌肺病的治疗结果

Treatment outcomes in NTM-PD in a high TB burden context.

作者信息

Kang S, Schmidt J E, Chen I, Tiberi S

机构信息

GSK, Beijing, China.

GSK, Siena, Italy.

出版信息

IJTLD Open. 2024 Dec 1;1(12):547-555. doi: 10.5588/ijtldopen.24.0413. eCollection 2024 Dec.

Abstract

BACKGROUND

Non-tuberculous mycobacterial (NTM) pulmonary disease (PD) is a significant concern in China, compounding the existing burden of TB. This review aims to summarise the treatment outcomes for NTM-PD in China.

METHODS

We reviewed the evidence on NTM-PD, including treatment regimens and clinical outcomes, from 17 studies identified through screening of three Chinese biomedical databases.

RESULTS

Antimicrobial treatment showed a microbiological cure rate ranging from 17.2% to 60.0% in studies with ≥50 NTM-PD patients, with lower rates observed among older and malnourished patients. The abscessus group (MC-AG) and -intracellulare complex (MAC) were the most prevalent NTM species in China. Higher microbiological cure rates were seen in MAC PD compared with MC-AG PD. The addition of cefoxitin and linezolid improved culture conversion rates in MC-AG-infected patients. One study ( = 24) demonstrated that resecting lesions and chemotherapy led to more favourable clinical outcomes.

CONCLUSION

Treatment regimens recommended in Chinese guidelines yielded poor-to-moderate outcomes for NTM-PD in China, highlighting the need for further research into alternative antimicrobial treatments to improve efficacy.

摘要

背景

非结核分枝杆菌(NTM)肺病(PD)在中国是一个重大问题,加重了现有的结核病负担。本综述旨在总结中国NTM-PD的治疗结果。

方法

我们通过筛选三个中国生物医学数据库确定的17项研究,回顾了关于NTM-PD的证据,包括治疗方案和临床结果。

结果

在≥50例NTM-PD患者的研究中,抗菌治疗的微生物治愈率在17.2%至60.0%之间,老年和营养不良患者的治愈率较低。脓肿分枝杆菌组(MC-AG)和胞内分枝杆菌复合体(MAC)是中国最常见的NTM菌种。与MC-AG-PD相比,MAC-PD的微生物治愈率更高。添加头孢西丁和利奈唑胺可提高MC-AG感染患者的培养转化率。一项研究(n = 24)表明,切除病变组织并进行化疗可带来更有利的临床结果。

结论

中国指南推荐的治疗方案对中国NTM-PD的治疗效果较差至中等,这突出表明需要进一步研究替代抗菌治疗方法以提高疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e074/11636495/a0b5094f881c/ijtldopen24-0413f1.jpg

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