非结核分支杆菌病

非结核分支杆菌病系由人、牛结核分支杆菌和麻风分支杆菌以外的非结核分支杆菌(nontuberculousmycobecteria,NTM)引起的疾病。NTM主要引起肺部病变,尚可引起全身其他部位病变,常见的是淋巴结炎、皮肤软组织感染和骨骼系统病变,对严重的细胞免疫抑制者还可引起血源性播散[1]。19世纪末,已有人从临床标本中分离到NTM,但直到本世纪50年代初鉴定分支杆菌不再仅依靠抗酸染色涂片、培养,而将细胞化学反应列入常规。同时因有效化疗使结核病疫情降低,NTM对人、动物的致病性始为人注意。1954年Timple和Runyon第一次系统地提出了分支杆菌的分类,…     

非结核分支杆菌病诊断方案修订刍议

自 198 7年在海南召开的全国非典型抗酸菌病研讨会制定了非典型分支杆菌诊断标准[1] 以来 ,已有 12年之久。随后 ,1993年在黄山市召开的非典型抗酸菌会议上正式将其定名为非结核分支杆菌 (ｎｏｎ ｔｕｂｅｒｃｕｌｏｕｓｍｙｃｏｂａｃｔｅｒｉｕｍ ,ＮＴＭ) ,与国际命名相一致。关于ＮＴＭ病的研究取得了一定的进展 ,并产生了一些新的认识[2 5] 。近年来 ,国外ＮＴＭ病的疫情呈现上升趋势 ,日本ＮＴＭ病的患病率由 1971年的 0 82 /10万上升到 1997年的 3 5 2 /10万 ,是 2 5年前的 3 8倍[6] 。美国的研究表明ＨＩＶ阳性者是感染ＮＴＭ的高…     

非结核分支杆菌病

非结核分支杆菌病何国钧潘非结核分支杆菌病系由人、牛结核分支杆菌和麻风分支杆菌以外的非结核分支杆菌（ｎｏｎｔｕｂｅｒｃｕｌｏｕｓｍｙｃｏｂａｃｔｅｒｉ－ａ，ＮＴＭ）引起的疾病。ＮＴＭ主要引起肺部病变，尚可引起全身其他部位病变，常见的是淋巴结炎、皮肤软...     

非结核分支杆菌病治疗的探讨

非结核分支杆菌病系由结核分支杆菌和麻风分支杆菌以外的非结核分支杆菌(ｎｏｎｔｕｂｅｒｃｕｌｏｕｓｍｙｃｏｂａｃｔｅｒｉａ,简称ＮＴＭ)引起的疾病。据文献[1]报告结果,并补充ＭＬｅｕｔｉｆｌａｖｕｍ[2],Ｍｂｒａｎｄｅｒｉｃ[3],ＭＬｉｎｄａ[4],Ｍｔｉｌｂｕｒｇｉｉ[5],ＭＷｏｏｄｐｉｇｅｏｎ[6]5个菌种等,迄今已发现ＮＴＭ100多种。Ｐｒｅｈｅｉｍ[7]按Ｒｕｎｙｏｎ分类将非结核分支杆菌病和病因学的种名列表表示。该表简明扼要,故将其作为表1列入,对于ＮＴＭ病治疗的探讨及思索,不无裨益。表1　非结核分支杆菌病和病因学种名…     

非结核分支杆菌病诊断与处理指南

一、绪论分支杆菌属内除结核分支杆菌复合群 (包括结核分支杆菌、牛分支杆菌、非洲分支杆菌、田鼠分支杆菌 )和麻风分支杆菌外统称为非结核分支杆菌 (ｎｏｎｔｕｂｅｒｃｕｌｏｕｓｍｙｃｏｂａｃｔｅｒｉａ,ＮＴＭ) ,其中部分是致病菌或条件致病菌。非结核分支杆菌病多继发于慢性肺病如支气管扩张、矽肺和肺结核 ,是人类免疫缺陷病毒 (ｈｕｍａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ ,ＨＩＶ)感染或获得性免疫缺陷综合征 (ａｃｑｕｉｒｅｄｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｓｙｎｄｒｏｍｅ ,ＡＩＤＳ)的常见并发症 ,也可以是因消…     

非结核分支杆菌病的流行趋势

结核分支杆菌以外的分支杆菌引发的肺部疾病越来越成为人们关注的课题。人类对非结核分支杆菌(ＮＴＭ)病的研究与认识,随着时间的推移逐渐深入。1950年以前,ＮＴＭ病仅有散在的病例报告;1950～1970年,人们研究了其组织学与诊断标准;1970年以后,人们提出了ＮＴＭ的分类与鉴定方法。现将近20余年来国内外ＮＴＭ病流行病学研究概述如下:一、病因及传播途径ＮＴＭ病由ＮＴＭ引起。ＮＴＭ是一种环境分支杆菌,主要源于污水、土壤、气溶胶。许多学者指出:至今这种病因学的理论变化不大。Ｋｉｒｓｃｈｎｅｒ等[1]报告:美国东南部酸性与褐色沼泽地带…     

非结核分支杆菌病诊治进展研讨会纪要

由中华医学会结核病学分会中华结核和呼吸杂志编辑委员会主办、深圳市医学会呼吸专业委员会协办的“非结核分支杆菌病诊治进展研讨会”,于1999年10月12～15日在深圳召开。来自全国各地的50余名代表与会,就非结核分支杆菌(ＮＴＭ)病的流行病学、诊断和治疗等问题进行了热烈讨论。现将会议交流的主要内容简介如下:一、流行病学非结核分支杆菌主要见于水、土壤和气溶胶,由于地理、气候、环境、经济、文化、医疗水平等不同,各国非结核分支杆菌病的流行情况各异。北京市结核病胸部肿瘤研究所的王忠仁研究员,向大会报告了日本、美国、法国、加拿大…     

为什么制定肺结核和非结核分支杆菌病诊治指南

结核病是严重危害人民健康的慢性传染病 ,80年代中、后期以来全球疫情急剧恶化形成新的回升高峰。细菌学涂片检查敏感性不高 ,培养费时长 ,阳性率低 ,临床肺结核患者 2 / 3以上为菌阴肺结核。这些患者主要依靠临床表现和胸部Ｘ线影像特征诊断 ,常存在漏诊和过诊现象。加上老年患者、合并糖尿病和免疫损害等肺结核患者的增多 ,也常使临床症状、胸部Ｘ线表现不典型 ,造成诊断上的困难。结核病的治疗 ,目前提倡医务人员直接督导下的短程化疗 (ＤＯＴＳ) ,使用规范的化疗方案 ,但在有些地方特别是在一些非结核病专科医院 ,不合理的化疗方案仍在…     

帕金森病的认知功能障碍不容忽视

随着解剖学、神经生物学、临床检测手段的发展和进步以及治疗方式的多样化，人们对帕金森病（Parkinson’s disease，PD）的认识越来越“丰满”：PD不再是一个单纯的运动障碍病，它还会影响到患者的认知功能、精神行为、自主神经和感觉系统，所以它是累及多个系统的一种神经变性疾病。据研究超过80％的PD患者会出现认知功能的改变，而约有30％的患者将最终发展为帕金森病痴呆（Parkinson’s disease with dementia，PDD）.如果说近两个世纪前，James Parkinson对PD的首次描述抓住了矛盾的主要方面——运动障碍，那么我们今天就来讨论一下矛盾的次要方面——认知障碍。     

不容忽视的沙门菌菌血症及其播散性感染

沙门菌属是肠杆菌科中最复杂的菌属。目前全球已分离出2 600多个血清型,其中200多个血清型对人体有致病性。沙门菌属根据临床表型分为伤寒沙门菌和非伤寒沙门菌,主要通过污染的食物及水源感染而致病。感染沙门菌的多数患者表现为急性胃肠炎,病程大多自限。少部分患者出现肠道外播散性感染,表现为菌血症与继发的迁徙病灶（如骨髓、关节...     

Nontuberculous mycobacteriosis mortality in Japan

The aim of this research was to clarify epidemiological characteristics of nontuberculous mycobacteriosis deaths in Japan. We analyzed the frequency of deaths due to nontuberculous mycobacteriosis (NTM) and regional differences using the Vital Statistics of Japan, published by the Ministry of Health, Labour and Welfare. The crude death rate was calculated using the Population Census of Japan published every 5 years (Ministry of Internal Affairs and Communications). In addition, changes in the proportions of death cases due to NTM disease among total autopsies were calculated using the Annual of the Pathological Autopsy in Japan (The Japanese Society of Pathology). RESULTS: NTM disease deaths appeared for the first time in 1970, with a marked increase by 2007, when there were 912 certified deaths. The increase was more marked after the mid-1990s. The number of women's deaths exceeded 300 in 1999 and reached 570 in 2007, while that of men exceeded 300 in 2001 and remained at nearly the same level until 2007. The death rate increased in all eight regions of Japan. The highest single-year regional death rate was 212 in Kanto in 2005. However, correcting by population size, the crude death rate was higher in the western regions of Japan than in the eastern ones. The proportion of NTM among total autopsies also showed an increase from 0.066% in 1993 to 0.304% in 2007. Included in the report is a comparison of trends of NTM deaths with those of major respiratory diseases including tuberculosis, emphysema, bronchial asthma and airway cancers.     

Nontuberculous mycobacteriosis; the present status of epidemiology and clinical studies]

In Japan, The Mycobacteriosis Research Group at the Japanese National Chest Hospitals has continuously made the clinico-epidemiological study of nontuberculous mycobacteriosis (NTM) since early 1970s. The prevalence rate was determined as 0.82, 0.91, 1.22, 1.74 and 2.43 per 100,000 population per year in 1971, 1975, 1980, 1985 and in 1990 respectively. The newest datum in 1997 was 3.52. These data indicates the prevalence rate has continuously increased and became 3.8 times than 25 years ago. While on the other hand, the prevalence rate of lung tuberculosis has decreased from 133.1 to 15.2, becoming one nines in the same period. The numbers of newly detected patients of lung mycobacteriosis in 1996 were also studied at 12 hospitals in Kinki district. The rate of NTM was 16.6% in 4 sanatorium hospitals, being about the same to the datum of The Mycobacteriosis Research Group. The rate of NTM in 8 general hospitals was surprisingly high, 40.0%. The 70% of NTM patients were infected with Mycobacterium avium complex (MAC). The 24% were with M. kansasii, and the only 6% were with other miscellaneous species. That is, the about one thirds or more of total NTM patients were female MAC desease patients, another one thirds or less were male MAC patients, and the more than 90% of M. kansasii patients (about one fourth of total patients) were male. These 3 groups took the most part of NTM patients. The rate of female MAC patients with small non-cavitary lesion without underlying diseases showed a tendency to increase, and the rate of male MAC patients with cavitary lesions with underlying lung or systemic diseases decreased. In 1997, American Thoracic Society (ATS) published the official statement about the diagnosis and treatment of NTM disease. The table-1 in that statement showed the new criteria for diagnosis of NTM pulmonary disease. It is useful for precise diagnosis of lung NTM disease, and the old criteria made by The Mycobacteriosis Research Group of the Japanese National Chest Hospitals is also useful for rough diagnosis. In the ATS statement, for adult HIV-negative MAC patients, minimum three drug regimen of clarithromycin (or azithromycin), rifabutin (or rifampin) and ethambutol, with intermittent streptomycin which is option for extensive disease, is recommended. This regimen is the same that most of the Japanese specialists for NTM disease recommended. The follow-up study of 47 Japanese MAC patients treated by the regimen contained clarithromycin with other anti-tuberculous drugs revealed that 80% of cases converted into bacilli negative and that the regimen had durable effect for at least 24 months. The resectional surgery may be considered for localized disease, and supportive nutritional treatment must also be considered for the MAC patients to whom the drug therapy was not effective, as if for the tuberculosis patients of multi-drug resistant.