目的 分析胞内分枝杆菌肺病与堪萨斯分枝杆菌肺病的胸部CT影像特征差异。方法 收集天津市海河医院胞内分枝杆菌肺病(A组)和堪萨斯分枝杆菌肺病(B组)各70例胸部CT图像,分析比较两组CT特征差异。结果 2组在性别、年龄上差异有统计学意义,A组小叶中心结节及树芽征、结节、厚壁空洞、支气管扩张比例均大于B组,A组薄壁空洞占比小于B组。A组分布在右肺上、下叶的空洞多于B组,右肺中叶支气管扩张少于B组。A组分布在右肺中叶、下叶及左肺上叶舌段、下叶的支气管扩张占比较B组多。结论 胞内分枝杆菌肺病病灶较堪萨斯分枝杆菌肺病多,以支气管扩张尤为明显,堪萨斯分枝杆菌肺病薄壁空洞较为显著。
Objective To compare and analyze CT imaging features differences between Mycobacterium intracellulare pulmonary disease and Mycobacterium kansasii pulmonary disease. Methods The CT images of 70 cases with Mycobacterium intracellulare lung disease(group A) and 70 cases with Mycobacterium kansasii lung disease(group B)were collected. The CT features of the two groups were compared by statistical analysis. Results The differences of gender and age between the two groups were statistically significant. The central nodule and tree-in-bud, nodule, thick wall cavity and bronchiectasis incidences in group A were more than those in group B. The thin wall cavity incidence in group A was less than those in group B. The number of cavities in the upper and lower lobe of the right lung in group A was bigger than group B,and the proportion of bronchiectasis in the middle lobe of the right lung in group A was less than those of group B. The bronchiectasis in the middle, lower lobe of right lung and upper lobe lingual segment and lower lobe of left lung in group A were more than those in group B. Conclusion The pulmonary lesion number of Mycobacterium intracellulare was bigger than that of Mycobacterium kansasii, especially bronchiectasis. The thin wall cavity of Mycobacterium kansasii pulmonary disease is more obvious.
目的 了解非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病患者免疫功能低下发生率,以及免疫支持的应用状况、探讨免疫支持治疗对患者2月末痰菌阴转及病变吸收的影响,为临床实施免疫干预提供参考依据。方法 分析广州市胸科医院2014年1月—2015年12月确诊的资料完整的381例NTM肺病患者免疫功能情况以及免疫支持的应用状况,观察组(加用免疫调节剂母牛分枝杆菌菌苗)228例与同期对照组(未使用免疫调节剂)153例进行2月末痰菌阴转及病变吸收情况比较。结果 381例患者中,免疫功能低下的发生率为45.67% (174／381);免疫支持率为59.84% (228／381)。细菌学改变:治疗前所有患者痰抗酸杆菌涂片和培养均为阳性。治疗2个月后两组的阴转率分别为67／228(29.38%)、17／153(11.11%),χ2=17.79,P<0.05。 影像学改变:两组的病变吸收有效率分别为62／228(27.19%)、16／153(10.45%),χ2=15.75,P<0.05;空洞吸收有效率分别为61／228(26.75%)、15／153(9.80%),χ2 =20.42,P<0.05。结论 非结核分枝杆菌肺病患者存在较高比例的免疫功能低下风险,观察组的痰茵阴转、病灶吸收和空洞闭合的疗效高于对照组。
Objective To explore the immune status of patients with nontuberculous mycobacterial(NTM) pulmonary disease, and the application of immunotherapy. to evaluate the influence of immunotherapy on sputum negative conversion and lesion absorption at the end of two months. provide reference data for immunotherapy. Methods The immune function and immunotherapy of 381 patients diagnosed as NTM pulmonary disease were retrospectively analyzed from January 2014 to December 2015 in Guangzhou Chest Hospital. Curative group (treated with antitubercular agents and immunomodulator mycobacterium vaccae) were compared with control group(treated with antitubercular agents alone) in sputum negative conversion and lesion absorption at the end of two month treatment. Results Of the 381 cases,45.67%(174／381)of the patients were immunocompromised, 59.84% (228／381)received immunotherapy. Bacteriologic changes: Both sputum smear and sputum culture were positive in all patents before treatment. after two months treatment, negative conversion in two groups were 67／228(29.38%),17／153(11.11%),χ2=17.79,P<0.05. 3. Radiological change: The rate of lesion absorption in curative group and control group were respectively 62／228(27.19%),16／153(10.45%),χ2=15.75,P<0.05;The rate of promoting cavity closure were respectively 61／228(26.75%),15／153(9.80%),χ2=20.42,P<0.05. Conclusion The immune function of NTM pulmonary disease had high ratio of being compromised. Curative group showed a significant effect of sputum negative conversion, lesion absorption and promoting cavity closure compared to the control group. Added to chemotherapy, M. vaccae is helpful in the treatment of nevertreated TB patients in terms of improving both Immunotherapy with M. vaccae had a beneficial influence on sputum negative conversion and X-ray appearances.
目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。
Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.
