老年支气管扩张合并非结核分枝杆菌感染的临床特征及其危险因素

目的分析老年支气管扩张合并非结核分枝杆菌(non-tuberculous mycobacterial,NTM)的临床特征及其危险因素。方法选择2015年1月-2019年12月无锡市第五人民医院呼吸与危重症科收治的老年支气管扩张患者为研究对象,其中120例合并NTM感染患者为合并感染组,120例为单纯支气管扩张组。分析合并NTM感染患者临床症状及影像学特点,采集痰液标本进行分枝杆菌鉴定及药敏试验,单因素及多因素Logistic回归分析支气管扩张合并NTM的危险因素。结果 120例合并NTM感染患者主要症状为咳嗽咯痰、咯血;影像学检查除典型的支气管扩张影外,还伴随有斑点、斑块、条索影,同时还有部分结节影、薄壁空洞表现,并且以1~2种征象为主,多种表现混合存在;累及3个以上肺野的患者占78.33%;痰抗酸杆菌涂片阳性率为86.67%(104/120)、痰NTM-DNA检测阳性率为90.00%(108/120);Ⅲ组鸟-胞内分枝杆菌复合菌群54例占45.00%,Ⅳ组龟-脓肿分枝杆菌复合菌群58例占48.33%,其他复合菌8例占6.67%;120株NTM对一、二线抗结核药物耐药率均较高,且全耐药者达到了38.33%(46/120);吸烟史>20年、支扩累及肺叶数≥5叶、薄壁空洞、CD₄⁺<550个/ml、低蛋白血症是老年支气管扩张合并NTM感染的独立危险因素(P<0.05)。结论老年支气管扩张合并NTM感染患者临床症状及影像学表现与肺结核相似,但对抗结核药物高度耐药,临床上可根据痰抗酸杆菌涂片及NTM-DNA检测对NTM感染进行判别,同时合并NTM感染受多种因素影响。

Clinical features of elderly bronchiectasis patients complicated with non-tuberculous Mycobacteria infection and risk factors

OBJECTIVE To investigate the clinical features of elderly bronchiectasis patients complicated with non-tuberculous mycobacteria(NTM)and analyze the risk factors.METHODS A total of 120 elderly bronchiectasis patients who were treated in department of respiratory and critical care of Wuxi Fifth People′s Hospital from Jan 2015 to Dec 2019 were recruited as the study subjects,120 patients who were complicated with NTM infection were assigned as the complicated infection group,and 120 patients were assigned as the simple bronchiectasis group.The clinical symptoms and imaging characteristics of the patients complicated with NTM infection were analyzed,the sputum specimens were collected for identification of Mycobacteria and drug susceptibility testing,and univariate analysis and multivariate logistic regression analysis were performed for risk factors for NTM infection in the elderly patients with bronchiectasis.RESULTS Cough,expectoration and hemoptysis were the major clinical manifestations of the 120 patients complicated with NTM infection;the results of imaging examination showed that beside the typical bronchiectasis shadow,there were spots,patchy,strip shadows,nodules,thin-walled cavities,1 or 2 signs were dominant,and there were mixture of multiple signs.The patients with no less than 3 lung fields involved accounted for 78.33%.The positive rates of acid-fast bacillus test of sputum smear and sputum NTM-DNA test were 86.67%(104/120)and 90.00%(108/120),respectively.There were 54 strains(45.00%)of avium-intracellular mycobacteria compound floras in the groupⅢ,58 strains(48.33%)of chelonae-abscess mycobacteria compound floras in the group IV,and 8 strains(6.67%)of other compound floras.The drug resistance rates of the 120 strains of NTM to the first and second-line anti-tuberculosis drugs were high,and the patients with total drug resistance accounted for 38.33%(46/120).The smoking history more than 20 years,number of bronchiectasis involved lung lobes no less than 5 pieces,thin-walled cavity,CD₄⁺less than 550 cells/mL and hypoalbuminema were the independent risk factors for the NTM infection in the elderly patients with bronchiectasis.CONCLUSION The clinical symptoms and imaging manifestations of the elderly patients with bronchiectasis and NTM infection are similar to those of the patients with tuberculosis,with high resistance to anti-tuberculosis drugs.Clinically,the NTM infection can be discriminated based on acid-fast bacillus test of sputum smear and sputum NTM-DNA test,and the NTM infection is affected by many factors.