Clinical and prognostic importance of serotyping Mycobacterium avium-Mycobacterium intracellulare complex isolates in human immunodeficiency virus-negative patients
Clinical and prognostic importance of serotyping Mycobacterium avium-Mycobacterium intracellulare complex isolates in human immunodeficiency virus-negative patients
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DOI：
10.1128/jcm.43.7.3150-3158.2005
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发表时间：
2005-07-01
影响因子：
9.4
通讯作者：
Ito, M
中科院分区：
文献类型：
--
作者：
Maekura, R;Okuda, Y;Ito, M
我们研究了鸟分枝杆菌-胞内分枝杆菌复合体（NMC）分离株的血清型是否决定肺MAC疾病的预后。我们前瞻性地监测了一个队列的68例肺MAC疾病患者，为他们在1990年和1995年使用薄层色谱法和快原子轰击质谱法确定的分离株中的亚型特异性糖肽脂。40/68例患者（58.8%）检出血清型4鸟分枝杆菌。其他血清型为血清型1（5例）、6（3例）、8（7例）、9（3例）、14（4例）和16（6例）。血清型4的患者明显（P < 0.01）比其他血清型的患者年轻（63.0 +/- 9.8岁）（71.8 +/- 10.3岁）。治疗失败的患者预后明显差于其他患者。治愈组无MAC相关死亡病例。36例（90%）血清4型患者的胸部影像学表现进行性恶化，14/36例死于肺结核引起的呼吸衰竭。血清4型患者的预后明显差于其他血清型患者。这些结果表明，化疗的结果和MAC分离株的血清型对于评估肺MAC疾病的预后是重要的。
We studied whether the serotypes of Mycobacterium avium-Mycobacterium intracellulare complex (NMC) isolates determine the prognosis for pulmonary MAC disease. We prospectively monitored a cohort of 68 patients with pulmonary MAC disease for whom the serotype-specific glycopeptidolipids in isolates were identified using thin-layer chromatography and fast atom bombardment mass-spectrometry in 1990 and 1995. Serovar 4 Mycobacterium avium was detected in 40/68 patients (58.8%). Other serotypes were serotypes 1 (five cases), 6 (three cases), 8 (seven cases), 9 (three cases), 14 (four cases), and 16 (six cases). Patients with serovar 4 were significantly (P < 0.01) younger (63.0 +/- 9.8 years) than patients with other serotypes (71.8 +/- 10.3). Patients who failed treatment had a significantly poorer prognosis than other patients. There were no cases of MAC-related death in the cured group. Chest radiographic findings progressively worsened in 36 (90%) of patients with serotype 4, and 14/36 died from respiratory failure caused by pulmonary Mycobacterium avium disease. The patients with serotype 4 had a significantly poorer prognosis than patients with other serotypes. These results show that both the outcome of chemotherapy and the serotypes of MAC isolates are important for assessing the prognosis of pulmonary MAC disease.