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中华移植杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 1 -6. doi: 10.3877/cma.j.issn.1674-3903.2024.01.001

专家论坛

器官移植受者非结核分枝杆菌病诊疗进展
巨春蓉1, 孙启全2, 薛武军3,†()   
  1. 1. 510120　广州医科大学附属第一医院　广州呼吸健康研究院呼吸疾病国家重点实验室　国家呼吸疾病临床医学研究中心
    2. 510315　广州，南方医科大学附属广东省人民医院肾移植科
    3. 710061　西安交通大学附属第一医院
  • 收稿日期:2023-10-24 出版日期:2024-02-25
  • 通信作者: 薛武军
  • 基金资助:
    呼吸疾病国家重点实验室/广州呼吸健康研究院/国家呼吸中心临床自主探索项目(SKLRHQN20205); 广东省钟南山医学基金会(ZNSA-2020013); 广东省自然科学基金(2022A1515012216); 广州呼吸健康研究院基础研究计划(202201020371); 广州市临床特色技术项目(2023C—TS10)

Advances in the diagnosis and treatment of non-tuberculous mycobacterial disease in organ transplant recipients

Chunrong Ju1, Qiquan Sun2, Wujun Xue3,†()   

  1. 1. The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
    2. Guangdong Provincial People′s Hospital of Southern Medical University, Guangzhou 510315, China
    3. The First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, China
  • Received:2023-10-24 Published:2024-02-25
  • Corresponding author: Wujun Xue
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巨春蓉, 孙启全, 薛武军. 器官移植受者非结核分枝杆菌病诊疗进展[J]. 中华移植杂志(电子版), 2024, 18(01): 1-6.

Chunrong Ju, Qiquan Sun, Wujun Xue. Advances in the diagnosis and treatment of non-tuberculous mycobacterial disease in organ transplant recipients[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(01): 1-6.

近年来，非结核分枝杆菌(NTM)感染导致的NTM病呈快速增长趋势，已成为威胁人类健康的重要公共卫生问题之一。实体器官移植(SOT)受者作为免疫功能受损人群，各种病原体感染的机会显著增加，包括NTM感染。NTM病可累及全身多个组织、脏器。对于肺移植受者，尤其是单肺移植受者，往往存在结构性肺病，罹患NTM肺病的风险更高。了解SOT受者NTM病的流行病学特点，熟悉不同NTM的特性，掌握NTM病的诊疗技术，有助于改善患者预后。本文参考美国胸科协会及欧洲呼吸协会发布的最新版《非结核分枝杆菌病治疗指南》以及中国《非结核分枝杆菌病诊断与治疗专家共识》和《器官移植受者非结核分枝杆菌病诊疗规范》，结合SOT受者人群特点，对SOT受者NTM病的发病情况、常见NTM病的临床特点、新型诊断技术及抗感染治疗策略等进行简要阐述，以期为临床提供参考。

关键词: 实体器官移植, 非结核分枝杆菌, 感染, 诊疗

Non-tuberculous mycobacteria (NTM) infection has become a significant public health concern due to its rapid increase in NTM disease. Solid organ transplant (SOT) recipients, as the immunocompromised hosts, are at significantly increased risk of infection by various pathogens, including NTM infections. NTM infections can cause damage to tissues and organs, resulting in NTM disease. This disease can affect multiple tissues and organs throughout the body. In lung transplant recipients, especially those who have undergone single-lung transplantation, or those who have pre-existing structure damaged lung disease, often are facing increased risk of developing NTM lung disease. Being familiar with the epidemiological characteristics of NTM disease and the characteristics of different kinds of NTM diseases in SOT recipients, and mastering the diagnostic and therapeutic techniques for this disease contributes to improving patient prognosis. This expert commentary refers to the latest version of the Guidelines for the Treatment of Non-Tuberculous Mycobacterial Disease issued by the American Thoracic Society and the European Respiratory Society, China′s Expert Consensus on the Diagnosis and Treatment of Non-Tuberculous Mycobacterial Disease, and the Diagnostic and Treatment Criteria for Non-Tuberculous Mycobacterial Disease in Organ Transplant Recipients, providing a brief description of the incidence of NTM disease in SOT recipients, the clinical characteristics of common NTM disease, novel diagnostic techniques, and different anti-infective therapeutic strategies, tailored to the characteristics of the population of SOT recipients to provide clinical references.

Key words: Solid organ transplantation, Non-tuberculous mycobacteria, Infection, Diagnosis and treatment
图1 实体器官移植受者非结核分枝杆菌肺病典型影像学表现注：a．女性42岁，心肺移植术后4年余，发热、咳嗽、胸痛，胸部CT表现为左下叶空洞，诊断非结核分枝杆菌肺病(伊朗分枝杆菌); b．男性58岁，双肺移植术后3年余，发热、咳嗽、咳痰，胸部CT表现为右中叶结节性支气管扩张，诊断非结核分枝杆菌肺病(脓肿分枝杆菌); c．女性35岁，右侧单肺移植后1年余，间断发热、咳嗽、胸闷，胸部CT表现为右上叶多发结节影及小空洞形成，诊断非结核分枝杆菌肺病(脓肿分枝杆菌)
1
唐神结，高文. 临床结核病学[M]. 2版. 北京：人民卫生出版社，2019：1026-1046.
2
Furuuchi K, Morimoto K, Yoshiyama T, et al. Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan[J]. Respir Med, 2019,152:74-80.
3
Prevots DR, Marras TK. Epidemiology of human pulmonary infection with nontuberculous mycobacteria: a review[J]. Clin Chest Med, 2015,36(1):13-34.
4
Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline[J]. Eur Respir J, 2020,56(1):2000535.
5
Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)[J]. Thorax, 2017,72(Suppl.2): ii1-ii64.
6
中华医学会结核病学分会，《中华结核和呼吸杂志》编辑委员会. 非结核分枝杆菌病诊断与治疗专家共识[J]. 中华结核和呼吸杂志，2012,35(8):572-580.
7
中华医学会器官移植学分会. 器官移植受者非结核分枝杆菌病临床诊疗技术规范(2019版)[J]. 器官移植，2019,10(4):364-368.
8
van Ingen J．Diagnosis of nontuberculous mycobacterial infections[J]. Semin Respir Crit Care Med, 2013,34(1):103-109.
9
George IA, Santos CA, Olsen MA, et al. Epidemiology and outcomes of nontuberculous mycobacterial infections in solid organ transplant recipients at a midwestern center[J]. Transplantation, 2016,100(5):1073-1078.
10
Smith GS, Ghio AJ, Stout JE, et al. Epidemiology of nontuberculous mycobacteria isolations among central North Carolina residents, 2006-2010[J]. J Infect, 2016,72(6):678-686.
11
Adjemian J, Daniel-Wayman S, Ricotta E, et al. Epidemiology of nontuberculous mycobacteriosis[J]. Semin Respir Crit Care Med, 2018,39(3):325-335.
12
Johansen MD, Herrmann JL, Kremer L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus[J]. Nat Rev Microbiol, 2020,18(7):392-407.
13
Winthrop KL, Marras TK, Adjemian J, et al. Incidence and prevalence of nontuberculous mycobacterial lung disease in a large U．S. managed care health plan, 2008-2015[J]. Ann Am Thorac Soc, 2020,17(2):178-185.
14
Wu J, Zhang Y, Li J, et al. Increase in nontuberculous mycobacteria isolated in Shanghai, China: results from a population-based study[J]. PLoS One, 2014, 9(10): e109736.
15
张洁，苏建荣，丁北川，等. 北京地区非结核分枝杆菌菌种分布及耐药性研究[J]. 中华结核和呼吸杂志，2017,40(3):210-214.
16
Baliga S, Murphy C, Sharon L, et al. Rapid method for detecting and differentiating Mycobacterium tuberculosis complex and non-tuberculous mycobacteria in sputum by fluorescence in situ hybridization with DNA probes[J]. Int J Infect Dis, 2018,75:1-7.
17
KunduracıH. Identification of mycobacteria species by molecular methods[J]. Int Wound J, 2020,17(2):245-250.
18
Ju CR, Lian QY, Guan WJ, et al. Metagenomic next-generation sequencing for diagnosing infections in lung transplant recipients: a retrospective study[J]. Transpl Int, 2022,35(2):10265.
19
Lian QY, Chen A, Zhang JH, et al. High-throughput next-generation sequencing for identifying pathogens during early-stage post-lung transplantation[J]. BMC Pulm Med, 2021,21(1):348.
20
Zhou X, Wu H, Ruan Q, et al. Clinical evaluation of diagnosis efficacy of active Mycobacterium tuberculosis complex infection via metagenomic next-generation sequencing of direct clinical samples[J]. Front Cell Infect Microbiol, 2019,9:351.
21
Shah SK, McAnally KJ, Seoane L, et al. Analysis of pulmonary non-tuberculous mycobacterial infections after lung transplantation[J]. Transpl Infect Dis, 2016,18(4):585-591.
22
Choi Y, Lee KS, Kim SK, et al. Unilateral lung involvement of nodular bronchiectatic Mycobacterium avium complex pulmonary diseases: proportion and evolution on serial CT studies[J]. AJR Am J Roentgenol, 2019,212(5):1010-1017.
23
Kwak N, Lee CH, Lee HJ, et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest[J]. Eur Radiol, 2016,26(12):4449-4456.
24
Renoult E, Fortin C, Dorais J, et al. Mycobacterium genavense and chronic intermittent diarrhea in a kidney and pancreas transplant recipient[J]. Transplantation, 2013,96(8):e64-e66.
25
Desikan P, Trivedi SK, Atlani MK. Pericardial effusion caused by Mycobacterium chelonae after renal transplant[J]. Arab J Nephrol Transplant, 2013,6(1):55.
26
Ishii K, Ishii N, Nakanaga K, et al. Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy[J]. J Dermatol, 2015,42(10):992-995.
27
Copeland NK, Arora NS, Ferguson TM. Mycobacterium haemophilum masquerading as leprosy in a renal transplant patient[J]. Case Rep Dermatol Med, 2013:793127.
28
Philley JV, Griffith DE. Medical management of pulmonary nontuberculous mycobacterial disease[J]. Thorac Surg Clin, 2019,29(1):65-76.
29
Richard M, Gutiérrez AV, Kremer L. Dissecting erm(41)-mediated macrolide-inducible resistance in Mycobacterium abscessus[J]. Antimicrob Agents Chemother, 2020,64(2): e01879-19.
30
Carvalho NFG, Pavan F, Sato DN, et al. Genetic correlates of clarithromycin susceptibility among isolates of the Mycobacterium abscessus group and the potential clinical applicability of a PCR-based analysis of erm(41)[J]. J Antimicrob Chemother, 2018,73(4):862-866.
31
Zhang Z, Lu J, Du Y, et al. Comparison of in vitro synergistic effect between clarithromycin or azithromycin in combination with amikacin against Mycobacterium intracellulare[J]. J Glob Antimicrob Resist, 2019,18:183-186.
32
Yoo JW, Jo KW, Kim SH, et al. Incidence, characteristics, and treatment outcomes of mycobacterial diseases in transplant recipients[J]. Transpl Int, 2016,29(5):549-558.
33
Jankovic Makek M, Pavlisa G, Jakopovic M, et al. Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature[J]. Transpl Infect Dis, 2016,18(1):112-119.
34
Swenson C, Del Parigi A. Amikacin liposome inhalation suspension as a treatment option for refractory nontuberculous mycobacterial lung disease caused by mycobacterium avium complex[J]. Mayo Clin Proc, 2020,95(1):201-202.
35
Choi Y, Jhun BW, Kim J, et al. Clinical characteristics and outcomes of surgically resected solitary pulmonary nodules due to nontuberculous mycobacterial infections[J]. J Clin Med, 2019,8(11): 1898.
36
Yamada K, Seki Y, Nakagawa T, et al. Outcomes and risk factors after adjuvant surgical treatments for Mycobacterium avium complex lung disease[J]. Gen Thorac Cardiovasc Surg, 2019,67(4):363-369.
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