Clinical Analysis And Efficacy Study Of Nontuberculous Mycobacterium Pulmonary Disease

Objective:To compare and analyze the clinical characteristics and efficacy of nontuberculous mycobacterium(NTM)pulmonary disease and tuberculosis,in order to provide reference for the clinical diagnosis and treatment of NTM.Methods:A retrospective study was conducted to include 140 NTM pulmonary disease patients who received treatment at the First and Second Affiliated Hospitals of Hainan Medical College from January 2020 to December 2022,as well as 138 tuberculosis patients who matched their gender and age.They were divided into the NTM pulmonary disease group and the tuberculosis group,respectively.Based on the hospital information system(HIS),various patient data were collected,including general data,laboratory examination data,chest CT examination data,sputum culture,drug sensitivity test and treatment.The specific research content is as follows:(1)Compare the clinical data of the NTM lung disease group and the tuberculosis group,and conduct binary logistic regression analysis to explore the risk factors of NTM lung disease onset;(2)On the basis of binary logistic regression analysis,the ROC curve was used to analyze the effectiveness of independent influencing factors in the differential diagnosis of NTM pulmonary disease and tuberculosis;(3)Calculate the distribution of pathogenic bacteria in NTM lung disease,compare clinical data of different pathogenic bacteria in NTM lung disease,and analyze clinical differences;(4)Analyze the drug resistance of different NTM pulmonary disease pathogens;(5)The clinical efficacy of NTM pulmonary disease patients after 6 months of treatment was counted,including the improvement of clinical manifestations,bacteriology efficacy,imaging efficacy,and comprehensive efficacy.Results:1.There were statistical differences between NTM pulmonary disease group and pulmonary tuberculosis group in pulmonary fungal infection,chronic obstructive pulmonary disease,diabetes,chest tightness,etc.(P<0.05);The percentage of neutrophils,hypersensitive C-reactive protein,and T-spot.TB positive rates in the NTM pulmonary disease group were lower than those in the pulmonary tuberculosis group,while the percentage of lymphocytes and albumin were higher than those in the pulmonary tuberculosis group,with significant differences(P<0.05);The proportion of bronchiectasis,involvement in the left upper lobe,and involvement in the right middle lobe in the NTM pulmonary disease group was higher than that in the pulmonary tuberculosis group,with significant differences(P<0.05);Binary logistic regression analysis showed that bronchodilation shadow was a risk factor for NTM lung disease(OR>1,P<0.05),while neutrophil proliferation,elevated hypersensitive C-reactive protein,decreased albumin,and T-spot.TB positivity were protective factors for NTM(OR<1,P<0.05).2.Through ROC curve analysis,the percentage of neutrophils,hypersensitive C-reactive protein,albumin,bronchodilator shadow,and T-spot.TB all have certain differential diagnostic value for NTM lung disease.The area under the curve(AUC)is 0.698,0.743,0.613,0.654,and 0.805,respectively.The combined AUC of all indicators is 0.910,which is higher than the differential diagnosis of a single indicator.3.A total of 8 NTM pathogens were detected in 140 patients with NTM pulmonary disease,all of which were single pathogen infections.Among them,86 cases were caused by slow growth group pathogens and 54 cases were caused by fast growth group pathogens,accounting for 61.43%and 38.57%respectively.The main pathogenic bacteria are Mycobacterium bird/cell and Mycobacterium turtle/abscess,accounting for 48.57%and 27.14%respectively.The comparison of various data of different pathogenic bacteria NTM pulmonary disease showed that the T-spot.TB positive rate of Mycobacterium Gordon was significantly higher than that of other pathogenic bacteria NTM pulmonary disease,with a significant difference(P<0.05).4.Drug sensitivity tests were conducted on the pathogenic bacteria of 140 NTM pulmonary disease patients,and the resistance rates of various pathogenic bacteria were generally high.Except for the low resistance rates of Mycobacterium Gordon,Mycobacterium Bird/Cell,and Mycobacterium Monkey to amikacin,the resistance rates of other drugs exceeded 50%;The resistance rates of the four fast-growing mycobacteria,namely Mycobacterium chelonianum/abscesses,Mycobacterium abscesses,Mycobacterium fortuitum,and Mycobacterium flavum,to various anti-tuberculosis drugs all exceed 50%.The resistance rates of slow growing Mycobacterium to rifampicin,ethambutol,amikacin,moxifloxacin,and aminosalicylic acid were lower than those of fast growing Mycobacterium,with statistical difference(P<0.05);There was no statistically significant difference in the resistance rate of different pathogenic bacteria to other anti tuberculosis drugs(P>0.05).5.After 6 months of treatment,the incidence of various clinical symptoms in patients with NTM pulmonary disease significantly decreased compared to before treatment,with statistical differences(P<0.05);After 6 months of treatment,the sputum bacteria conversion rate was 41.43%,the effective absorption rate of chest CT plain scan lesions was 60.00%,the effective rate of cavity improvement was 57.14%,and the comprehensive effective rate was 59.28%.Conclusions:1.There is a certain difference between NTM pulmonary disease and pulmonary tuberculosis patients.Bronchial dilation is a risk factor for NTM pulmonary disease(OR>1,P<0.05),while neutrophil count,elevated hypersensitive C-reactive protein,decreased albumin,and T-spot.TB positive are protective factors for NTM(OR<1,P<0.05).2.The percentage of neutrophils,hypersensitive C-reactive protein,albumin,bronchodilator shadow,and T-spot.TB all have certain differential diagnostic value for NTM lung disease,and the combination of various indicators has higher differential diagnostic efficacy.3.There are various types of pathogenic bacteria for NTM lung disease,with the main pathogenic bacteria being Mycobacterium avium/cell and Mycobacterium turtle/abscess.Different pathogenic bacteria lack obvious characteristics in NTM lung disease patients,and only have certain differences in T-spot.TB positive rates.4.Various pathogenic bacteria of NTM pulmonary disease generally have high resistance to first-line treatment drugs for tuberculosis,especially fast-growing Mycobacterium.5.The clinical treatment effect of NTM pulmonary disease is not satisfactory.In addition to significant improvement in clinical symptoms,the sputum bact eria conversion rate,lesion absorption rate,cavity improvement rate,and com prehensive effective rate are all low.