PDF(Pubmed)
Abstract：
Nontuberculous mycobacteria (NTM) are environmental and ubiquitous, but only a few species are associated with disease, often presented as nodular/bronchiectatic or cavitary pulmonary forms. Bronchiectasis, airways dilatations characterized by chronic productive cough, is the main presentation of NTM pulmonary disease. The current Cole\'s vicious circle model for bronchiectasis proposes that it progresses from a damaging insult, such as pneumonia, that affects the respiratory epithelium and compromises mucociliary clearance mechanisms, allowing microorganisms to colonize the airways. An important bronchiectasis risk factor is primary ciliary dyskinesia, but other ciliopathies, such as those associated with connective tissue diseases, also seem to facilitate bronchiectasis, as may occur in Lady Windermere syndrome, caused by M. avium infection. Inhaled NTM may become part of the lung microbiome. If the dose is too large, they may grow excessively as a biofilm and lead to disease. The incidence of NTM pulmonary disease has increased in the last two decades, which may have influenced the parallel increase in bronchiectasis incidence. We propose that ciliary dyskinesia is the main promoter of bronchiectasis, and that the bacteria most frequently involved are NTM. Restoration of ciliary function and impairment of mycobacterial biofilm formation may provide effective therapeutic alternatives to antibiotics.
摘要：
非结核分枝杆菌（NTM）是环境和普遍存在的，但是只有少数物种与疾病相关，常表现为结节性/支气管扩张或空洞性肺形式。支气管扩张,以慢性生产性咳嗽为特征的气道扩张，是NTM肺部疾病的主要表现。当前Cole对支气管扩张的恶性循环模型提出，它是从破坏性的侮辱发展而来的，比如肺炎,影响呼吸道上皮并损害粘膜纤毛清除机制，允许微生物在呼吸道定殖。支气管扩张的重要危险因素是原发性纤毛运动障碍，但其他纤毛病,例如与结缔组织疾病相关的疾病，似乎也促进了支气管扩张，就像温德米尔夫人综合症一样，由鸟分枝杆菌感染引起的。吸入的NTM可能成为肺部微生物组的一部分。如果剂量太大,它们可能作为生物膜过度生长并导致疾病。NTM肺病的发病率在过去的二十年中有所增加，这可能影响了支气管扩张发病率的平行增加。我们认为纤毛运动障碍是支气管扩张的主要促进因素，最常见的细菌是NTM。纤毛功能的恢复和分枝杆菌生物膜形成的损害可以提供抗生素的有效治疗替代方案。
