鸟分枝杆菌复合群肺病合并重度肾功能不全一例并文献复习

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1、万方数据中华老年医学杂志2013年lo月第32卷第10期ChinJGeriatr，Q!!!!!!!!!!!y!!：!；：塑!：!!鸟分枝杆菌复合群肺病合并重度肾功能不全一例并文献复习丁勇钟雪锋方保民柯会星孙铁英陈启航1069·临床研究·【摘要】目的探讨鸟分枝杆菌复合群(MAC)肺病的诊断及治疗，为提高该病的临床诊治水平提供依据。方法分析我院诊治的经诱导痰培养结合临床确诊为MAC肺病合并慢性肾脏病4期的1例老年患者临床资料，并复习国内外相关文献。结果80岁重度营养不良老年男性患者1例，进行性体质量下降伴

2、乏力、盗汗，体质量仅43～44kg，胸部CT表现为双肺多发小结节、小斑片影、磨玻璃影，PET／CT表现为代谢活性增高的结节及斑片影，约4年病史。经支气管镜检查肺泡灌洗液(BALF)培养阴性，经高渗盐水诱导咳痰，痰培养鉴定为MAC。患者肾小球滤过率(GFR)左肾9．0ml／min，右肾18．8ml／min，选择治疗药物困难，常规的抗结核药物低度一高度耐药，加用莫西沙星治疗肾功能不全加重而停用，选用阿奇霉素0．25g／d、3次／周，利福喷汀0．3g／d、2次／周，乙胺丁醇0．375g／d、3次／周治疗，联

3、合母牛分枝杆菌疫苗(微卡)免疫治疗病情趋于稳定。结论PET／CT鉴别肺结核及MAC肺病无意义；合并严重肾功能不全的低体质量的老年MAC肺病患者，治疗困难，应采取个体化治疗，积极改善患者营养状态，并辅以增强免疫治疗；同时应在密切观察不良反应的情况下慎重选择抗MAC药物，可以取得较为满意的临床效果。【关键词】分枝杆菌，非典型性；肾功能不全InducedsputumculturefortheidentificationofMycobacteriumaviumcomplexlungdiseasewithsev

4、ererenalinsufficiency：acasereportandreviewDINGYong+，ZHONGXue-feng，FANGBao-min，KEHui—xing。SUNTie—ying，CHENQi—hang．’DepartmentofRespiratoryInternalMedicine，BeijingHospitalofMinistryofHealth，Beijingj00730，ChinaCorrespondingauthor：KEHui—xing，Email：kehx@sina

5、．com[Abstract]ObjectiveTostudythediagnosisandtreatmentofMycobacteriumaviumcomplexlungdiseasewithsevererenalinsufficiency，andtOprovideabasisforimprovingtheclinicaIdiagnosisandtreatmentofMAClungdiseasewithsevererenalinsufficiency．MethodsClinicaldataofanel

6、derlypatientwithMACIungdiseaseconfirmedbyinducedsputumcultureandcomplicatedwithchronickidneydisease(CKD4)wasreported．Therelated1iteraturesathomeandabroadwerereviewed．ResultsAmalepatientaged80yearswithpoornutritionwassufferingfromprogressiveweightloss，ex

7、haustionandnightsweats．Hisweightwasonly43—44Kg．ChestCTshowedthatmultiplesmallnodules，smallspotpiecesofshadowandgroundglassshadowsinbilaterallungtissues．PET。／CTindicatedthatspotpiecesandnoduleswithmetabolicactivityinhighperformance．Bronchoalveolarlavagef

8、luid(BALF)inspectionwasnegative．MACwasidentifiedbyinducedsputumculturethroughhighpermeabilitybrineinducedsputum．ItwasdifficulttochoosedrugsforthetreatmentofMAClungdiseaseduetohispoorkidneyfunctionEGFRofleftkidney：9．0ml／rain，GFRof