CAJ | 학술논문

目的：探讨应用机械通气的老年患者非结核分枝杆菌（NTM）肺病的临床特征。方法回顾性分析解放军总医院4例老年机械通气合并NTM肺病患者的病历资料，并复习相关文献。结果4例患者均合并慢性阻塞性肺疾病、特发性间质性肺炎、支气管扩张症等慢性肺部基础病，确诊前均曾被疑诊为肺结核。临床症状无特异性，均有发热和咯痰，1例合并痰中带血。胸部CT表现多样，呈结节影、片状实变影和胸腔积液等，未出现典型的结节支气管扩张型和纤维空洞型征象。分枝杆菌培养均可见快速生长分枝杆菌，菌种鉴定1例为龟分枝杆菌，3例为脓肿分枝杆菌。1例脓肿分枝杆菌肺病患者接受药物治疗，其余3例因多器官功能障碍而未行抗分枝杆菌治疗，4例均死于多器官功能衰竭。结论 NTM是导致老年呼吸机相关肺炎的病原菌，感染症状无特异性，典型NTM肺病影像特征并不常见。对痰抗酸杆菌染色阳性的老年机械通气患者应重视NTM的培养和菌种鉴定。
목적：탐토응용궤계통기적노년환자비결핵분지간균（NTM）폐병적림상특정。방법회고성분석해방군총의원4례노년궤계통기합병NTM폐병환자적병력자료，병복습상관문헌。결과4례환자균합병만성조새성폐질병、특발성간질성폐염、지기관확장증등만성폐부기출병，학진전균증피의진위폐결핵。림상증상무특이성，균유발열화각담，1례합병담중대혈。흉부CT표현다양，정결절영、편상실변영화흉강적액등，미출현전형적결절지기관확장형화섬유공동형정상。분지간균배양균가견쾌속생장분지간균，균충감정1례위구분지간균，3례위농종분지간균。1례농종분지간균폐병환자접수약물치료，기여3례인다기관공능장애이미행항분지간균치료，4례균사우다기관공능쇠갈。결론 NTM시도치노년호흡궤상관폐염적병원균，감염증상무특이성，전형NTM폐병영상특정병불상견。대담항산간균염색양성적노년궤계통기환자응중시NTM적배양화균충감정。
Objective To study the clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary diseases in elderly patients with mechanical ventilation. Methods Four elderly patients with mechanical ventilation who companied with NTM pulmonary disease were selected, and a retrospective analysis was made with literature review. Re-sults The underlying structural lung diseases were common among these subjects and included chronic obstructive pul-monary disease (COPD), pulmonary fibrosis, old tuberculosis and bronchiectasia. All of these patients were suspected to have tuberculosis before the final diagnosis. Clinical symptoms were non-specific,including fever, expectoration, and haemoptysis occurred in one patient. The CT findings were not characteristic, including nodules, patchy infiltrations and pleural effusion, and absence of the classical fibrocavitary and nodular bronchiectatic patterns. Mycobacteria cultures were positive with the rapid growth of mycobacteria. Bacteria type identifications had been performed with Mycobacterium ab-scessus (3 cases) and Mycobacterium chelonei (1 case). Only one patient with Mycobacterium abscess was treated with chemotherapy, while the other 3 patients were not treated due to multi-organ dysfunction. All these patients died of multiple organ failure. Conclusion NTM, especially rapidly progressive mycobacteria infection, is one of the causes of ventilator associated pneumonia in elderly patients. Symptoms may be non-specific and imaging features of typical NTM lung disease is uncommon. Mycobacteria cultures and accurate NTM species identification should be performed in order to avoid misdiagnosis.