Objective To analyze the risk factors of pulmonary non-tuberculous mycobacterial (NTM) infection in sputum acid-fast bacilli positive and/or mycobacteria culture positive patients.Methods One hundred and sixty-three patients with pulmonary NTM infection were recruited from Jan 2006 to Jun 2011 in Shanghai Pulmonary Hospital and 326 patients with sputum positive pulmonary tuberculosis who were selected by random systemic sampling method in the same period were recruited as control.The data were retrospectively analyzed.The related factors were compared between groups by chi-square test.The risk factors of pulmonary NTM infection were analyzed by binary Logistic regression model.Results There were statistically significant differences of age,history of smoking,chronic obstructive pulmonary disease (COPD),bronchiectasis,thin walled cavities focus,purified protein derivative (PPD) test between patients with pulmonary NTM infection and patients with pulmonary tuberculosis (all P＜0.05).Univariate analysis showed that age [45-60year (OR=2.637,95％CI:1.631-4.264; P＜0.001); ＞60 year (OR=4.194,95％CI:2.581-6,813 ; P＜0.001)],history of smoking [10-20 year (OR=1.842,95％CI:1.0843.070; P=0.024),＞20 year (OR=2.040,95％CI:1.167-3.567; P=0.012)],COPD (OR=2.698,95％CI:1.588-4.583; P＜0.001),bronchiectasis (OR=3.566,95％CI:2.343-5.427;P＜0.001),thin walled cavities focus (OR=2.592,95％CI:1.581-4.250; P＜0.001) and a weak-positive reaction of PPD test (OR=2.389,95％CI:1.276-4.472; P=0.006) were all risk factors of pulmonary NTM infection.Multivariate analysis showed that age＞60 year (OR=3.961,95％CI:2.183-7.189 ; P＜0.001),bronchiectasis (OR =3.880,95 ％ CI:2.342-6.487 ; P＜0.001),thin walled cavities focus (OR=2.898,95％CI:1.567-5.360; P＜0.001),COPD (OR=2.503,95％ CI:1.289-4.857; P=0.007),age45-60 year (OR=2.452,95％CI:1.391 4.325; P=0.002)anda weak-positive reaction of PPD test (OR=2.295,95％CI..1.132-4.652; P=0.021) were independent risk factors of pulmonary NTM infection.Conclusion In sputum acid-fast bacilli positive and/or mycobacteria culture positive patients,age≥ 45 year,COPD,bronchiectasis,thin walled cavities focus and a weak-positive reaction of PPD test are risk factors of pulmonary NTM infection.The clinicians should pay close attention to the results of species identification.%目的 探讨痰抗酸杆菌涂片和(或)培养阳性的患者患非结核分枝杆菌(NTM)肺病的相关危险因素.方法 选择2006年1月至2011年6月的痰抗酸杆菌涂片和(或)培养阳性的NTM肺病患者163例(NTM肺病组),对同期入院的痰抗酸杆菌涂片和(或)培养阳性肺结核患者采用系统抽样法随机抽取326例作为对照组,进行回顾性研究.采用x2检验对两组的研究因素进行比较,并应用Logistic回归分析筛选出NTM肺病的相关危险因素.结果 NTM肺病患者与肺结核患者年龄、吸烟史、慢性阻塞性肺病(COPD)、支气管扩张、肺内空洞、PPD结果的差异均有统计学意义(均P＜0.05).单因素分析显示,年龄[45～60岁(OR=2.637,95％CI为1.631～4.264,P＜0.001)、＞60岁(OR=4.194,95％CI为2.581～6.813,P＜0.001)]、吸烟史[10～20年(OR=1.842,95％CI为1.084～3.070,P=0.024)、＞20年(OR=2.040,95％CI为1.167～3.567,P=0.012)]、COPD(OR=2.698,95％CI为1.588～4.583,P＜0.001)、支气管扩张(OR=3.566,95％CI为2.343～5.427,P＜0.001)、肺内薄壁空洞(OR=2.592,95％CI为1.581～4.250,P＜0.001)、PPD弱阳性(OR=2.389,95％CI为1.276～4.472,P=0.006)均为NTM肺病的危险因素.多因素分析显示,年龄＞60岁(OR=3.961,95％CI为2.183～7.189,P＜0.001)、支气管扩张(OR=3.880,95％CI为2.342～6.487,P＜0.001)、肺内薄壁空洞(OR=2.898,95％CI为1.567～5.360,P＜0.001)、COPD(OR=2.503,95％CI为1.289～4.857,P=0.007)、年龄45～60岁(OR=2.452,95％CI为1.391～4.325,P=0.002)、PPD弱阳性(OR=2.295,95％CI为1.132～4.652,P=0.021)均为NTM肺病的危险因素.结论 年龄≥45岁、COPD、支气管扩张、肺内薄壁空洞、PPD弱阳性的痰抗酸杆菌涂片和(或)培养阳性患者患NTM肺病的危险性显著增加,临床医师应密切关注菌种鉴定的结果.
展开▼
