近年来,非结核性分枝杆菌肺病(NTM-PD)的发病率有所增加。然而,NTM-PD患者的临床和免疫学特征很少受到关注.
NTM菌株,临床症状,潜在的疾病,肺部CT表现,淋巴细胞亚群,并对NTM-PD患者进行药敏试验(DST)。然后,采用主成分分析(PCA)和相关分析评价NTM-PD患者的免疫细胞计数及其相关性。
2015年至2021年,北京某三级医院收治NTM-PD患者135例,健康对照者30例。NTM-PD患者的数量每年都在增加,和细胞内分枝杆菌(M.细胞内),M.脓肿,M.avium,NTM-PD的主要病原体是Kansasii。NTM-PD患者的主要临床症状为咳嗽和咳痰,主要肺部CT表现为薄壁腔,支气管扩张,和结节。此外,我们从87例具有菌株记录的NTM-PD患者中鉴定出23株临床分离株.DST显示,几乎所有的脓肿分枝杆菌和鸟分枝杆菌以及超过一半的细胞内分枝杆菌和鸟分枝杆菌复合物组对本研究中测试的抗结核药物具有抗性。异形分枝杆菌对所有氨基糖苷类抗生素均有抗性。KansasiiM.对卡那霉素有100%的抗性,卷曲霉素,阿米卡星,和对氨基水杨酸,对链霉素敏感,乙胺丁醇,左氧氟沙星,阿奇霉素,和利福霉素.与其他药物相比,在NTM-PD分离株中观察到对利福布汀和阿奇霉素的低耐药性。此外,NTM-PD患者的先天免疫细胞和适应性免疫细胞的绝对计数明显低于HC。PCA和相关分析表明,总T,CD4+,CD8+T淋巴细胞在NTM-PD患者的保护性免疫中起着至关重要的作用,它们之间存在强烈的正相关。
北京NTM-PD发病率逐年上升。已显示患有支气管扩张和COPD的个体对NTM-PD高度易感。NTM-PD患者的特点是免疫功能受损,非特异性临床症状,高耐药性,成像时的薄壁腔损伤,以及显着减少的先天和适应性免疫细胞的数量。
The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased in recent years. However, the clinical and immunologic characteristics of NTM-PD patients have received little attention.
NTM strains, clinical symptoms, underlying diseases, lung CT findings, lymphocyte subsets, and drug susceptibility tests (DSTs) of NTM-PD patients were investigated. Then, the counts of immune cells of NTM-PD patients and their correlation were evaluated using principal component analysis (PCA) and correlation analysis.
135 NTM-PD patients and 30 healthy controls (HCs) were enrolled from 2015 to 2021 in a certain tertiary hospital in Beijing. The number of NTM-PD patients increased every year, and Mycobacterium intracellulare (M. intracellulare), M. abscessus, M. avium, and M. kansasii were the major pathogens of NTM-PD. The main clinical symptoms of NTM-PD patients were cough and sputum production, and the primary lung CT findings were thin-walled cavity, bronchiectasis, and nodules. In addition, we identified 23 clinical isolates from 87 NTM-PD patients with strain records. The DST showed that almost all of M. abscessus and M. avium and more than half of the M. intracellulare and M. avium complex groups were resistant to anti-tuberculosis drugs tested in this
study. M. xenopi was resistant to all aminoglycosides. M. kansasii was 100% resistant to kanamycin, capreomycin, amikacin, and para-aminosalicylic acid, and sensitive to streptomycin, ethambutol, levofloxacin, azithromycin, and rifamycin. Compared to other drugs, low resistance to rifabutin and azithromycin was observed among NTM-PD isolates. Furthermore, the absolute counts of innate and adaptive immune cells in NTM-PD patients were significantly lower than those in HCs. PCA and correlation analysis revealed that total T, CD4+, and CD8+ T lymphocytes played an essential role in the protective immunity of NTM-PD patients, and there was a robust positive correlation between them.
The incidence of NTM-PD increased annually in Beijing. Individuals with bronchiectasis and COPD have been shown to be highly susceptible to NTM-PD. NTM-PD patients is characterized by compromised immune function, non-specific clinical symptoms, high drug resistance, thin-walled cavity damage on imaging, as well as significantly reduced numbers of both innate and adaptive immune cells.