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目的 分析非结核分枝杆菌（nontuberculous mycobacteria, NTM）肺病的临床特征，为该病的早期临床诊治提供新的理论依据。方法 回顾性分析广西医科大学第一附属医院2019年1月1日至2022年8月31日确诊的81例NTM肺病患者资料，以同期收治的92例肺结核患者为对照，收集患者的临床数据，包括一般资料、实验室检查、胸部高分辨率计算机断层扫描（high resolution computerized tomography, HRCT）、菌种鉴定等信息进行统计学分析。结果 NTM肺病患者平均年龄为53.86±16.76岁，女性占比56.79%，有吸烟史者占比22.22%，常见临床表现为咳嗽咳痰（72.84%）、咯血（35.80%）等。合并支气管扩张（32.10%）、陈旧性肺结核（19.75%）等疾病多见。胸部HRCT以斑片状影（92.59%）、结节影（67.90%）等为主，两肺受累最多（53.09%）。2组在性别分布、吸烟史、咯血症状、合并疾病（如支气管扩张）、实验室检查[如淋巴细胞百分比（lymphocyte percentage, Lym%）]、胸部影像学表现（如支气管扩张影）上的差异具有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，合并支气管扩张和陈旧性肺结核患者患NTM肺病可能性大。菌种鉴定共分离出22个菌种，快速生长型以脓肿分枝杆菌复合群最多（38.71%）；缓慢生长型以鸟分枝杆菌复合群（Mycobacterium avium-intracellulare complex, MAC）最多（53.41%），尤以胞内分枝杆菌最多。职业分布上，农民在两类NTM肺病中最多（32.26%,35.09%），且农民患者性别差异具有统计学意义（P<0.05）。结论 NTM肺病患者以女性农民居多，吸烟占比低，常伴咯血，多合并支气管扩张及陈旧性肺结核，Lym%升高，胸部HRCT呈多肺叶病变及支气管扩张影。NTM肺病以缓慢生长型MAC为主要菌种，其中胞内分枝杆菌最为常见。
Abstract：Objective The clinical characteristics of nontuberculous mycobacteri(NTM) pulmonary disease were analyzed in order to provide a new theoretical basis for the early clinical diagnosis and treatment of the disease. Methods A retrospective analysis was conducted on the data of 81 patients diagnosed with NTM pulmonary disease in the First Affiliated Hospital of Guangxi Medical University from January 1, 2019 to August 31, 2022. 92 patients with pulmonary tuberculosis admitted during the same period were used as the control group. Clinical data, including general characteristics, laboratory tests, high resolution computerized tomography(HRCT) of the chest, and mycobacterial strain identification of the patients were collected for statistical analysis. Results The mean age of patients with NTM pulmonary disease was 53.86 ± 16.76 years. 56.79% were female and 22.22% had a history of smoking. Common clinical manifestations included cough and expectoration(72.84%), hemoptysis(35.80%), etc. Bronchiectasis(32.10%), old pulmonary tuberculosis(19.75%) and other diseases are more common. Chest HRCT mainly showed patchy shadows(92.59%), nodular shadows(67.90%), etc. The proportion of involvement in both lungs was the highest(53.09%). The differences between the 2 groups in terms of gender distribution, smoking history, hemoptysis symptoms, concurrent diseases(such as bronchiectasis), laboratory tests [such as lymphocyte percentage(Lym%)], and chest imaging manifestations(such as bronchiectasis shadows) were statistically significant(P<0.05). Multivariate Logistic regression analysis concluded that the combination of bronchiectasis and old pulmonary tuberculosis indicated a high possibility of having NTM pulmonary disease. A total of 22 strains (88 cases) were isolated during the strain identification. Among the fast-growing types, the complex of Mycobacterium abscessus accounted for the largest proportion(38.71%). The slow-growing type was characterized by the largest proportion(53.41%) of Mycobacterium avium-intracellulare complex(MAC), especially intracellular Mycobacterium. In terms of occupational distribution, farmers accounted for the largest proportion(32.26%, 35.09%) in the 2 types of NTM pulmonary diseases, and the gender difference among farmer patients was statistically significant(P<0.05). Conclusion The majority of patients with NTM pulmonary disease were female farmers with a low prevalence of smoking, frequently presenting with hemoptysis. The diseases were commonly associated with bronchiectasis and old pulmonary tuberculosis, along with an elevated Lym%. HRCT revealed multi-lobar involvement and bronchiectatic shadows. The predominant causative organism was slow-growing MAC, with intracellular mycobacteria being the most frequently identified species.
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基本信息:
中图分类号:R563
引用信息:
[1]侯小兰,曾梓淞,杨霞.非结核分枝杆菌肺病临床特征分析[J].传染病信息,2026,39(03):285-292.
2026-06-30
2026-06-30