Tsuda M, Oishi N, Saeki A, Ogawa K, Honda K, Sasamoto M, Michihiro H, Miwa T
Department of Medicine, Tokoname City Hospital, Aichi, Japan.
Kekkaku. 1995 Jun;70(6):369-76.
In Japan the number of patient infected with M. avium complex (MAC) has been increasing in contrast to a decrease of pulmonary tuberculosis. DNA probe method enabled us be able to differentiate an isolated MAC into M. avium and M. intracellulare. From 1991 to 1992, we performed an investigation to apply this new technique of the DNA probe method on 52 patients of atypical mycobacteriosis diagnosed as infected with MAC by the ordinary method at the Higashi Nagoya National Hospital. The group consisted of 27 males and 25 females. M. avium infection was found in 39 patients (M. avium group) and M. intracellulare in 16 patients (M. intracellulare group). No significant gender difference was found between two groups. The M. avium group showed more complications in contrast to the M. intracellulare group. As complications in the M. avium group, pulmonary aspergillus infection, bacterial pneumonia and bronchiectasis were found in 4, 3 and 2 cases, respectively. The rate of drug resistance to antituberculosis drugs was high in the both groups. Chemotherapy with isoniazid (INH) rifampin (RFP) and streptomycin (SM) in five patients, that with INH, RFP and ethambutol (EB) in three were found to be effective after 4 months treatment. Three patients in M. avium group died of respiratory failure, aspergillus infection and renal failure. In contrast the prognosis of patients in the M. intracellulare group seemed to be better as there was no fatal case. We conclude that DNA probe method is useful to differentiate between M. avium and M. intracellulare, and enable us to select more appropriate selection of the chemotherapy and to assess of the prognosis.
在日本，与肺结核病例数减少形成对比的是，鸟分枝杆菌复合群（MAC）感染患者的数量一直在增加。DNA探针法使我们能够将分离出的MAC区分为鸟分枝杆菌和胞内分枝杆菌。1991年至1992年，我们在名古屋东部国立医院对52例非典型分枝杆菌病患者进行了一项调查，这些患者通过常规方法被诊断为感染了MAC。该组包括27名男性和25名女性。39例患者被发现感染鸟分枝杆菌（鸟分枝杆菌组），16例患者感染胞内分枝杆菌（胞内分枝杆菌组）。两组之间未发现明显的性别差异。与胞内分枝杆菌组相比，鸟分枝杆菌组出现更多并发症。作为鸟分枝杆菌组的并发症，分别在4例、3例和2例患者中发现了肺部曲霉菌感染、细菌性肺炎和支气管扩张。两组对抗结核药物的耐药率都很高。5例患者使用异烟肼（INH）、利福平（RFP）和链霉素（SM）进行化疗，3例患者使用INH、RFP和乙胺丁醇（EB）进行化疗，4个月治疗后发现有效。鸟分枝杆菌组有3例患者死于呼吸衰竭、曲霉菌感染和肾衰竭。相比之下，胞内分枝杆菌组患者的预后似乎更好，因为没有致命病例。我们得出结论，DNA探针法有助于区分鸟分枝杆菌和胞内分枝杆菌，使我们能够选择更合适的化疗方案并评估预后。
