广州医科大学学报

目的:探讨临床常见的鸟-胞内分枝杆菌复合群(MAC)肺病和龟-脓肿分枝杆菌肺病患者的临床特点。方法:回顾性分析我院2008年1月-2017年12月收治的85例MAC肺病和92例龟-脓肿分支杆菌肺病患者的临床与影像资料、T淋巴细胞亚群和营养指标结果,旨在提高非结核分枝杆菌(NTM)肺病的治疗水平。结果:(1)龟-脓肿组患者外周血CD3⁺、CD4⁺、CD8~+T淋巴细胞明显低于MAC组,差异有统计学意义(P<0.05)。(2)临床症状无特异性,营养不良发生率高,分别为82.4%和73.9%;MAC患者年龄较龟-脓肿患者偏大,差异有统计学意义(P<0.05)。(3)影像表现:两组患者均容易侵犯多个肺野与合并支气管扩张,病灶范围在4个肺野以上例数、合并空洞数差异均无统计学意义(P>0.05)。结论:临床常见的MAC与龟-脓肿分支杆菌肺病患者均以呼吸道症状与营养不良为主要表现;多肺野侵犯与空洞形成为特征的结构性肺病以及细胞免疫损伤可考虑为长期反复的支气管扩张并NTM感染的致病结果。

Objective:To investigate the clinical features of pulmonary infections with Mycobacterium avium-intracellulare Complex(MAIC) and Mycobacterium chelonae-abscessus complex(MCAC), two clinically common lung diseases. Methods:A retrospective analysis was performed on clinical and imaging data, T lymphocyte subsets and nutritional indicators among 85 patients with MAIC lung disease and 92 with MCAC lung disease treated in our hospital between January 2008 and December 2017, aiming at improving our management of non-tuberculous mycobacteria(NTM) lung disease. Results:(1) The peripheral blood CD3⁺, CD4⁺ and CD8⁺ T lymphocytes in the MCIC group were significantly lower than those in the MCAC group, with statistically significant differences(P<0.05).(2) In these patients, the clinical symptoms were non-specific, and incidence rate of malnutrition was fairly high(82.4% and 73.9%, respectively). The patient age in the MAIC group was elder compared with the MCAC group, with statistically significant difference(P<0.05).(3) For image findings, the both groups were frequently found to have multiple lung-field involvement and bronchiectasis. The two group did not differ significantly in number of the cases with>four lung-field involvement and the overall number of cavities(P>0.05). Conclusion:Clinically common lung infections with MAIC and MCAC are mainly characterized by respiratory symptoms and malnutrition. Structural lung destruction characterized by multiple lung-field involvement and cavitation, as well as impaired cellular immune may result from long-term recurrent bronchiectasis and the pathogenic effect of NTM infection.