摘要
目的分析长期吸入糖皮质激素(激素)的慢性阻塞性肺疾病(慢阻肺)患者继发非结核分枝杆菌肺病的临床特点。方法回顾性分析2017年1月至2018年12月在我院诊治的慢阻肺并发非结核分枝杆菌肺病患者的临床-影像学资料。共纳入有完整的临床-肺功能-胸部HRCT资料(基线及感染非结核分枝杆菌后)的慢阻肺患者15例,男10例,女5例,年龄平均(66±7)岁。结果15例中仍吸烟者4例,已戒烟既往有吸烟史6例,5例无吸烟史。所有患者均正在使用吸入激素,其中氟替卡松8例,布地奈德7例;疗程3~61个月,平均(27±10)个月。咳嗽、咯痰增加(15/15)及呼吸困难加重(10/15)是常见的临床表现,但发热并不常见(4/15)。所有患者外周血白细胞及淋巴细胞计数均正常,部分ESR及C反应蛋白升高(7/15),绝大部分患者(14/15)外周血结核感染T细胞斑点试验正常。多数患者基线胸部HRCT有不同程度和形式的肺结构破坏,其中多灶性支气管扩张9例,明显肺气肿12例。发生非结核分枝杆菌感染后,胸部HRCT以新发支气管扩张(15/15)、"树芽征"(12/15)及小空洞影(8/15)多见。大部分经痰培养明确病原(13/15),仅2例经BALF培养明确诊断(2/15)。非结核分枝杆菌的菌种以鸟/胞内分枝杆菌为主(8/15)。结合菌种鉴定结果给予针对性抗感染治疗后,大部分好转(9/15),部分治愈(4/15),少数复发(2/15)。结论长期吸入激素治疗的慢阻肺患者若出现咳嗽、咯痰及呼吸困难加重,但发热并不明显、复查胸部CT提示新发支气管扩张、"树芽征"时,需要排查结核或非结核分枝杆菌感染的可能,及时送检痰结核菌培养、菌种鉴定或DNA测序等,以尽早明确诊断、针对性抗感染治疗,改善患者的预后。
Objectives Long-term use of inhaled corticosteroids(ICS)was reported as a risk factor for patients with chronic obstructive pulmonary disease(COPD)complicated with nontuberculous mycobacterial lung disease(NTM-LD).But it was not reported often in China.Methods We conducted a retrospective analysis of patients who were diagnosed with COPD and NTM-LD in our department from January 1st 2017 to December 31th 2018.ResultsThis study consisted of 10 male and 5 female patients with a mean age of(66±7)years.The detailed clinical data and radiological images were reviewed systemically.There were 4 current smokers(26.7%)and 6 past smokers(40%).All cases were current ICS users,with a mean duration of(27.3±9.7)months,ranging from 3 months to 61 months.Among them,8 cases(53.3%)used inhaled fluticasone and 7 cases(46.7%)used inhaled budesonide.Aggravated coughing(15 cases,100%),expectoration(15 cases,100%)and dyspnea(10 cases,66.7%)were the common clinical manifestations,although fever was only reported in 4 cases(26.7%).All cases showed normal white blood cell count and lymphocyte count,and some of them(7 cases,46.7%)showed elevated erythrocyte sedimentation rate and C-reactive protein.Most of them(14 cases,93.3%)had normal TB-SPOT results.Multiple focal bronchiectasis(9 cases,60%)and significant emphysema(12 cases,80%)were the common manifestations of basic high-resolution CT(HRCT)prior NTM infection.The occurrence of bronchiectasis(15 cases,100%),"tree in bud"sign(12 cases,80%)and tiny cavities(8 cases,53.3%)were the common HRCT abnormalities for the NTM-LD cases.According to the 2007′s NTM-LD diagnosis criteria,most of them(13 cases,86.7%)were diagnosed with positive sputum samples at least twice,and 2 cases were diagnosed with positive CT-directed bronchial alveolar lavage fluid.NTM-PCR analysis was performed routinely for the isolated NTM samples to identify the NTM species.Mycobacterium avium complex(MAC)was the most common NTM species(8 cases,53.3%).After treatment with proposed anti-NTM strategies,most cases improv
作者
孙宇新
邵池
李珊
徐凯
黄慧
徐作军
Sun Yuxin;Shao Chi;Li Shan;Xu Kai;Huang Hui;Xu Zuojun(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Beijing 100730,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2019年第11期826-831,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金青年科学基金项目(81600050)
科技部国家重点研发计划精准医学研究重点项目(2016YFC0905700)
中央高校基本科研业务费专项资金和协和青年基金(3332016003)。
关键词
肺疾病
慢性阻塞性
分枝杆菌感染
吸入激素
Pulmonary disease,chronic obstructive
Mycobacterium infections
Inhaled corticosteroids
