Characterizing Non-Tuberculous Mycobacteria Infection in Bronchiectasis
Characterizing Non-Tuberculous Mycobacteria Infection in Bronchiectasis
复制标题
DOI：
10.3390/ijms17111913
复制
发表时间：
2016-11-01
影响因子：
5.6
通讯作者：
Aliberti, Stefano
中科院分区：
文献类型：
--
作者：
Faverio, Paola;Stainer, Anna;Aliberti, Stefano
慢性气道感染是支气管扩张症发病机制的一个关键方面。非结核分枝杆菌（NTM）感染引起了越来越多的关注。我们的目的是描述支气管扩张症合并肺部NTM（pNTM）疾病患者的临床特征、诊断过程、治疗选择和结局。这是一项前瞻性、观察性研究，入组了2012年至2015年在意大利蒙扎圣杰拉多医院（San Gerardo Hospital，Monza，Italy）接受稳定状态治疗的261例成人支气管扩张患者。确定了三组：pNTM疾病;慢性铜绿假单胞菌感染;由于铜绿假单胞菌以外的细菌引起的慢性感染。32例（12%）患者分离出NTM，其中23例确诊为pNTM疾病。与慢性铜绿假单胞菌感染相比，pNTM患者更可能患有圆柱形支气管扩张和“树芽”模式，体重减轻史，疾病严重程度较低，肺部恶化次数较少。在开始治疗的pNTM患者中，68%的患者显示放射学改善，37%的患者实现了培养转化而无复发，而21%的患者显示NTM分离复发。NTM分离似乎是支气管扩张患者的常见事件，很少有参数可能有助于怀疑NTM感染。治疗指征和监测仍然是未来研究的重要领域。
Chronic airway infection is a key aspect of the pathogenesis of bronchiectasis. A growing interest has been raised on non-tuberculous mycobacteria (NTM) infection. We aimed at describing the clinical characteristics, diagnostic process, therapeutic options and outcomes of bronchiectasis patients with pulmonary NTM (pNTM) disease. This was a prospective, observational study enrolling 261 adult bronchiectasis patients during the stable state at the San Gerardo Hospital, Monza, Italy, from 2012 to 2015. Three groups were identified: pNTM disease; chronic P. aeruginosa infection; chronic infection due to bacteria other than P. aeruginosa. NTM were isolated in 32 (12%) patients, and among them, a diagnosis of pNTM disease was reached in 23 cases. When compared to chronic P. aeruginosa infection, patients with pNTM were more likely to have cylindrical bronchiectasis and a "tree-in-bud" pattern, a history of weight loss, a lower disease severity and a lower number of pulmonary exacerbations. Among pNTM patients who started treatment, 68% showed a radiological improvement, and 37% achieved culture conversion without recurrence, while 21% showed NTM isolation recurrence. NTM isolation seems to be a frequent event in bronchiectasis patients, and few parameters might help to suspect NTM infection. Treatment indications and monitoring still remain an important area for future research.