关键词: 分枝杆菌, 鸟复合, 肺疾病, 体征和症状, 治疗结果, 危险因素

Abstract:

Objective To analyze the clinical characteristics of Mycobacterium avium complex (MAC) lung disease, and to explore the risk factors of the therapeutic effect. Methods Seventy-five patients with MAC lung disease hospitalized in Fuzhou Pulmonary Hospital of Fujian Province from October 2017 to December 2018 and treated and followed up regularly more than one year were retrospectively analyzed. Medical history of all the patients was complete, sputum or bronchoalveolar lavage fluid samples were positive by mycobacterium culture, and the species identification was clear. The patients were divided into different groups by results of the mycobacterium sputum culture 1-year after anti-nontuberculous mycobacteria (NTM) treatment. Single factor analysis was used to explore the effects of gender, age, nutritional status, basic disease/comorbidity, with or without cavity, with or without bronchiectasis, regular treatment or not and four empirical combination regimens of regular treatment. Results Among the 75 patients with MAC lung disease, intracellular subtypes accounted for 78.7% (59/75); and bird subtypes accounted for 21.3% (16/75). 54.7% (41/75) were female, and 61.3% (46/75) aged over 60 years old. Of the patients, 97.3% suffered underlying diseases/comorbidities, among them, bronchiectasis accounted for 76.0% (57/75), previous history of tuberculosis accounted for 32.0% (24/75), pneumoconiosis accounted for 16.0% (12/75), and chronic obstructive pulmonary disease (COPD) accounted for 12.0% (9/75). The main clinical symptoms were cough and expectoration (96.0%, 72/75), shortness of breath (44.0%, 33/75), hemoptysis (34.7%, 26/75), fever (21.3%, 16/75), and chest tightness (16.0%, 12/75). As for imaging manifestations, nodular bronchiectasis was the most common type (76.0%, 57/75), followed by fibrous cavity type (68.0%, 51/75) and solitary nodule type (4.0%, 3/75). The negative conversion rate of mycobacterium sputum culture in MAC lung disease after 1-year-treatment was 60.0% (45/75); male, history of COPD and irregular treatment (sputum negative conversion rates were 47.1% (16/34), 2/9, and 1/6, respectively) were the risk factors of sputum bacteria without negative conversion. Conclusion The patients with history of bronchiectasis, tuberculosis, COPD, pneumoconiosis, diabetes and low immunity were mostly likely to suffer MAC lung disease, the bacteria should be identified in time; MAC lung disease has a low sputum bacteria negative conversion rate. The understanding of NTM lung disease should be strengthened for male patients, patients with COPD history and irregular treatment. The patients’ doubts should be removed in time, and the adverse drug reactions in treatment should be actively dealt with.

Key words: Mycobacterium avium complex, Lung diseases, Signs and symptoms, Treatment outcome, Risk factors