摘要
目的:对老年与非老年脓肿分枝杆菌肺病(Mycobacterium abscessus pulmonary disease,MAB-PD)患者的临床特点、耐药情况进行比较,对MAB-PD患者预后进行影响因素分析。方法:选择2021年1月1日至2023年5月31日期间就诊于首都医科大学附属北京胸科医院确诊的123例MAB-PD患者(老年组48例,非老年组75例),收集患者的临床资料、药物敏感性试验结果及治疗结局,对两组患者的临床特点进行比较,对患者预后影响因素进行分析。结果:老年MAB-PD患者空洞发生率为41.7%(20/48),高于非老年MAB-PD患者[24.0%(18/75)];胸膜粘连比例为66.7%(32/48),也高于非老年MAB-PD患者[46.7%(35/75)],差异均有统计学意义(χ^(2)=4.279,P=0.039;χ^(2)=4.721,P=0.030)。多因素logistic分析显示:年龄≥65岁(OR=2.532,95%CI:1.048~6.120)、BMI<18.5kg/m2(OR=4.379,95%CI:1.758~10.905)、胸膜粘连(OR=3.566,95%CI:1.420~8.955)是患者治疗失败的危险因素。结论:老年MAB-PD患者以空洞、胸膜粘连为主要特征。高龄、低BMI、胸膜粘连是MAB-PD患者治疗失败的危险因素,临床上需要针对高龄、营养不良及影像出现粘连患者制定个体化干预措施。
Objective:To compare the clinical characteristics and drug resistance profiles between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease(MAB-PD),and to analyze the prognostic factors influencing treatment outcomes.Methods:A total of 123 patients diagnosed with MAB-PD at Beijing Chest Hospital,Capital Medical University,from January 1,2021,to May 31,2023,were enrolled and divided into an elderly group(48 patients,age≥65 years)and a non-elderly group(75 patients,age<65 years).Clinical data,drug susceptibility testing results,and treatment outcomes were collected.The clinical features of the two groups were compared,and prognostic factors associated with treatment outcomes were analyzed.Results:The incidence of cavitary lesions was significantly higher in elderly MAB-PD patients(41.7%(20/48))compared to non-elderly patients(24.0%(18/75)).The proportion of patients with pleural adhesion was also significantly greater in the elderly group(66.7%(32/48))than in the non-elderly group(46.7%(35/75))(χ^(2)=4.279,P=0.039;χ^(2)=4.721,P=0.030,respectively).Multivariate logistic analysis identified age≥65 years(OR=2.532,95%CI:1.048-6.120),BMI<18.5 kg/m2(OR=4.379,95%CI:1.758-10.905),and the presence of pleural adhesion(OR=3.566,95%CI:1.420-8.955)as independent risk factors for treatment failure.Conclusion:Elderly patients with MAB-PD are more likely to present with pulmonary cavities and pleural adhesions.Advanced age,low BMI,and pleural adhesion are significant risk factors for treatment failure in MAB-PD patients.Individualized management strategies should be considered for elderly patients,those with malnutrition,and those exhibiting pleural adhesions on imaging.
作者
尚园园
聂文娟
初乃惠
Shang Yuanyuan;Nie Wenjuan;Chu Naihui(Department of Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department I of Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)
出处
《中国防痨杂志》
北大核心
2026年第1期106-112,共7页
Chinese Journal of Antituberculosis
基金
北京市高层次公共卫生人才项目(G2022-3-020)
北京重大呼吸道传染病研究中心课题(BJRID2025-013)
北京市医管中心扬帆3.0项目(ZLRK202331)
首都医科大学临床专科学院(系)培养基金开放课题(CCMU2024ZKYXY011)。
关键词
老年
分枝杆菌感染
非典型性细菌
抗药性
治疗结局
Aged
Mycobacterium infections
Atypical bacterial forms
Drug resistance
Treatment outcomes
