免疫支持对非结核分枝杆菌肺病患者疗效影响

摘要

Objective To explore the immune status of patients with nontuberculous mycobacterial(NTM) pulmonary disease, and the application of immunotherapy. to evaluate the influence of immunotherapy on sputum negative conversion and lesion absorption at the end of two months. provide reference data for immunotherapy. Methods The immune function and immunotherapy of 381 patients diagnosed as NTM pulmonary disease were retrospectively analyzed from January 2014 to December 2015 in Guangzhou Chest Hospital. Curative group (treated with antitubercular agents and immunomodulator mycobacterium vaccae) were compared with control group(treated with antitubercular agents alone) in sputum negative conversion and lesion absorption at the end of two month treatment. Results Of the 381 cases,45.67%(174/381)of the patients were immunocompromised, 59.84% (228/381)received immunotherapy. Bacteriologic changes: Both sputum smear and sputum culture were positive in all patents before treatment. after two months treatment, negative conversion in two groups were 67/228(29.38%),17/153(11.11%),x2=17.79,P<0.05. 3. Radiological change: The rate of lesion absorption in curative group and control group were respectively 62/228(27.19%),16/153(10.45%),x2=15.75,P<0.05;The rate of promoting cavity closure were respectively 61/228(26.75%),15/153(9.80%),x2=20.42,P<0.05. Conclusion The immune function of NTM pulmonary disease had high ratio of being compromised. Curative group showed a significant effect of sputum negative conversion, lesion absorption and promoting cavity closure compared to the control group. Added to chemotherapy, M. vaccae is helpful in the treatment of nevertreated TB patients in terms of improving both Immunotherapy with M. vaccae had a beneficial influence on sputum negative conversion and X-ray appearances.%目的 了解非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病患者免疫功能低下发生率,以及免疫支持的应用状况、探讨免疫支持治疗对患者2月末痰菌阴转及病变吸收的影响,为临床实施免疫干预提供参考依据.方法 分析广州市胸科医院2014年1月-2015年12月确诊的资料完整的381例NTM肺病患者免疫功能情况以及免疫支持的应用状况,观察组(加用免疫调节剂母牛分枝杆菌菌苗)228例与同期对照组(未使用免疫调节剂)153例进行2月末痰菌阴转及病变吸收情况比较.结果 381例患者中,免疫功能低下的发生率为45.67% (174/381);免疫支持率为59.84% (228/381).细菌学改变:治疗前所有患者痰抗酸杆菌涂片和培养均为阳性.治疗2个月后两组的阴转率分别为67/228(29.38%)、17/153(11.11%),x2=17.79,P<0.05. 影像学改变:两组的病变吸收有效率分别为62/228(27.19%)、16/153(10.45%),x2=15.75,P<0.05;空洞吸收有效率分别为61/228(26.75%)、15/153(9.80%),x2 =20.42,P<0.05.结论 非结核分枝杆菌肺病患者存在较高比例的免疫功能低下风险,观察组的痰茵阴转、病灶吸收和空洞闭合的疗效高于对照组.