非结核分枝杆菌肺病的回顾性分析

目的：分析湖南省长沙市中心医院近3年来非结核分枝杆菌(nontuberculous mycobacteria，NTM)肺病 患者的临床特征及耐药情况。方法：回顾性分析2014年2月至2017年5月于湖南省长沙市中心医院确诊的153例 NTM肺病患者临床资料，根据药敏试验浓度分为低浓度组和高浓度组，检测两组的药物敏感性及耐药状况。 结果：153例患者中男79例(51.63%)，女74例(48.37%)，年龄为(60.27±19.46)岁；NTM 肺病常见于支气管扩张患者， 病程较长(平均7.8年)， 临床症状无特异性，极易误诊为肺结核(92.81%)。菌种以鸟/胞内分枝杆菌(56.21%)和龟/脓肿 分枝杆菌(20.92%)多见；对一线、二线抗结核药的耐药率高，多数耐 8 种药物以上，其中低浓度组38.56%的患者全部耐药，高浓度组25.49%的患者全部耐药。结论：NTM肺病极易误诊，且耐药率高，NTM的菌种鉴定和药物敏感性检测对临床的诊断和治疗有重要的指导作用。

Nontuberculous mycobacteria pulmonary disease: A retrospective analysis

Objective: To analyze the clinical characteristics and drug resistance in patients with nontuberculous mycobacteria (NTM) pulmonary disease in Changsha Central Hospital of Hunan Province in recent three years. Methods: The clinical data of 153 patients with NTM pulmonary disease, who were diagnosed in Changsha Central Hospital of Hunan Province from February 2014 to May 2017, were retrospectively analyzed. According to the concentration of drug sensitivity test, the patients were divided into a low concentration group and a high concentration group. The status of drug sensitivity and drug resistance were examined. Results: Among 153 patients, 79 patients (51.63%) were male, 74 patients (48.37%) were female. The mean ages were (60.27±19.46) years. The NTM pulmonary disease mainly occurred in the individuals with bronchiectasis, and the course of disease was long (mean 7.8 years). The clinical symptoms were not specific and mostly misdiagnosed as pulmonary tuberculosis (92.81%). Mycobacterium avium-intracellulare (56.21%) and mycobacterium chelonae-abscess (20.92%) were the majority. The drug-resistance rate of the first-line and second-line anti-tuberculosis drugs was high. The majority was resistant to more than eight drugs, 38.56% patients in the low concentration group were resistant to total drugs, and 25.49% patients in the high concentration group were resistant to total drugs. Conclusion: The NTM pulmonary disease is easily misdiagnosed, and the drug resistance rate is high. Identification of mycobacterium species and detection of drug sensitivity play an important role in clinical diagnosis and treatment.