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目的观察不同个体化治疗方案治疗非结核分枝杆菌(NTM)肺病的临床疗效和安全性,探讨该病的治疗方法。方法参照美国胸科协会指南,根据患者用药史及药敏试验结果,从亚胺培南-西司他丁、厄他培南、利奈唑胺、头孢西丁、阿奇霉素、克拉霉素、阿米卡星、妥布霉素、莫西沙星、环丙沙星、左氧氟沙星、乙胺丁醇、利福布汀、多西环素中选取适合药物组合个体化化疗方案治疗20例非结核分枝杆菌肺病患者。设计总疗程在1年以上,全疗程观察患者症状、细菌学改善情况,影像学表现和安全性指标。结果 20例研究对象其中混合两种以上NTM分离菌株者18例(90%),共分离出NTM菌株68株,龟类NTM占多数(50%),克拉霉素及阿米卡星耐药率较低(<40%)。20例患者治疗时间(13.6±4.34)个月,12例发热患者在治疗1周内体温恢复正常,咳嗽、咳痰、血痰、胸液、气促等症状均明显改善。治疗6个月后痰菌阴转8例(42.1%);细菌量减少3例(15%);影像学方面病灶好转率63.1%,空洞好转率64.3%。不良反应以胃肠道为主11例(55%),8例(40%)出现血液系统不良反应,5例(25%)出现肝损,2例出现过敏、静脉炎,1例因不良反应退出治疗观察,其余病例经暂停用药或减量治疗并对症处理后好转。结论鸟胞分枝杆菌复合群及快生长群的龟类NTM菌群是NTM肺病主要致病菌群。针对不同患者的实际情况组合以阿米卡星和克拉霉素为主的个体化治疗方案,对NTM肺病有较满意的疗效和临床可耐受的不良反应。临床症状改善明显,影像学改善满意,痰菌阴转率有待进一步提高。加强药敏检测技术,调整更合理的个体化方案,开展更大样本的临床研究是治疗NTM肺病的关键。
Objective To observe the clinical efficacy and safety of different individualized treatment regimens in the treatment of non-tuberculous mycobacterium tuberculosis (NTM) lung disease and to explore the treatment of the disease. Methods According to the American Thoracic Society guidelines, according to the history of drug use and drug susceptibility test results from imipenem - cilastatin, ertapenem, linezolid, cefoxitin, azithromycin, clarithromycin, amoeba Carding star, tobramycin, moxifloxacin, ciprofloxacin, levofloxacin, ethambutol, rifabutin, doxycycline in the selection of appropriate drug combination of individual chemotherapy in the treatment of 20 cases of non-tuberculous mycobacteria Patients with lung disease. The total design of the course of more than 1 year, the whole course of treatment to observe the patient’s symptoms, bacteriological improvement, imaging findings and safety indicators. Results Twenty patients (90%) were mixed with two or more isolates of NTM in 20 patients. A total of 68 strains of NTM were isolated, and the majority of turtle NTM (50%), clarithromycin and amikacin resistance rates Lower (<40%). The treatment time of 20 patients (13.6 ± 4.34) months, 12 cases of fever in patients with fever within 1 week returned to normal, cough, sputum, bloody sputum, pleural effusion and other symptoms were significantly improved. After 6 months of treatment, 8 cases (42.1%) had sputum negative conversion; 3 cases (15%) had bacterial reduction; and the imaging improvement rate was 63.1% and the improvement rate of cavity was 64.3%. Adverse reactions mainly occurred in 11 cases (55%) in the gastrointestinal tract and 8 cases (40%) in the blood system. Liver damage occurred in 5 cases (25%), allergy and phlebitis in 2 cases, and adverse reactions Exit treatment observation, the rest of the cases were suspended medication or reduction treatment and symptomatic treatment improved. Conclusion The NTM flora of Mycobacterium vaccae complex and fast growing group is the main pathogenic group of NTM lung disease. According to the actual situation of different patients combined with amikacin and clarithromycin-based individualized treatment programs, NTM lung disease have more satisfactory efficacy and clinical tolerability of adverse reactions. Clinical symptoms improved significantly, imaging improved satisfaction, sputum negative conversion rate to be further improved. Strengthening drug susceptibility testing techniques, adjusting more rational individualized programs and conducting larger sample clinical studies are the key to the treatment of NTM lung disease.