66例非结核分支杆菌肺病的临床分析

目的　了解非结核分支杆菌 (NTM)肺病的临床特征。方法 对 1998—2002年 4年间广州地区 4129例分支杆菌培养阳性的病例中，经菌型鉴定而确诊为NTM肺病的资料完整的 66例病例进行分析。结果 66例NTM肺病中，快速生长型感染的有 40例，其中脓肿分支杆菌 29例，龟分支杆菌 7例，耻垢分支杆菌 3例和偶然分支杆菌 1例；慢速生长型感染的有 26例，其中鸟分支杆菌 18例，胞内分支杆菌 6例，蟾分支杆菌和海分枝杆菌各 1例。分枝杆菌混合感染的有 10例；新发现病例16例，病程在 1～10年的有 31例，11～25年 11例，30年以上的有 8例；主要症状依次为咳嗽、咳白粘痰、咯血和发热；X线胸片示两侧受累者达 69.7%，右侧 21.2%，左侧仅有 4.5%，无病灶者占4.5%；出现胸腔积液的有 7例；NTM对抗结核药物呈现高度的原始耐受性，但对喹诺酮类、大环内脂类和氨基糖甙类的耐药率相对较低。结论 NTM肺病的临床特征无特异性，病程长，常规的抗结核治疗效果差。

Clinical Analysis of 66 cases with pulmonary disease caused by Nontuberculosis Mycobacteria

Objective To research on the clinical symptom of pulmonary disease caused by Nontuberculosis Mycobacteria(NTM). Methods Bacteria type identifications have been performed with 4129 cases of positive culture which have been isolated in Guangzhou from 1998 to 2002. 66 cases in final diagnosis were pulmonary disease caused by NTM and the full data about it were analyzed. Results 40 of the 66 cases were infected with rapid growth Mycobacteria , 29 of which were M.abscessus , 7 were M.chelonae , 3 were M.smegmatis and 1 was M.fortuitum . 26 of the 66 cases were infected with slow growth mycobacteria, 18 of which were M.avium , 6 were M.intracellulare , 1 was M.xenopi and 1 M.marinum .There were 10 Mycobacterium mixed infection. 16 cases were discovered lately, 31 cases have suffered for 1 to 10 years, 11cases for 11 to 25 years and 8 cases for over 30 years. The main symptoms were cough, expectorate white phlegm, hemoptysis and fever, respectively. Thoracic cavity with X-ray Irradiation showed that 69.69 percent of it were damaged in the both sides, 21.21 percent in the right, only 4.54 percent in the left, and 4.54 percent of it without focus. 26 cases involved in thoracic cavity membrane, 7 of which occurred in gathering liquid, NTM showed highly original resistance to the anti-tuberculosis drugs, but the ratio of resistance to quinolones, macrolides and aminogiycosides was lower.Conclusion The clinical symptom of pulmonary disease caused by NTM is not characteristic and has a long progress. There is a inferior effect of therapy with routine anti-tuberculosis drugs.