耐药非结核分枝杆菌肺部疾病治疗进展

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摘要非结核分枝杆菌（NTM）感染常引起肺部疾病，其中最常见的病原菌为鸟分枝杆菌、脓肿分枝杆菌和堪萨斯分枝杆菌。不同病原菌的治疗药物有所不同，菌种鉴定是有效治疗的前提，基于指南用药仍是最基础的治疗手段并有助于改善预后，但耐药性的产生使治疗成功率下降。了解耐药性产生的机制及病原菌的特性可为新药物的研究提供靶点，但目前还没有能应用于临床患者的新药。因此重新探索已有药物的治疗效果可作为治疗方案的选择之一，本文综述了以上3种病原菌引起NTM肺病的指南基础用药及产生耐药性后的治疗方案选择。

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	魏华英杨洋仵永枫画伟张玉林▲

关键词 ：非结核分枝杆菌, 治疗, 耐药, 人类免疫缺陷病毒

Abstract：Nontuberculous mycobacterial (NTM) infection often causes pulmonary disease, and the most common pathogens are Mycobacterium avium, Mycobacterium abscessus and Mycobacterium kansasii. The therapeutic drugs for different pathogens are different. The identification of bacterial species is the prerequisite for effective treatment. The use of drugs based on guidelines is still the most basic treatment and helps to improve the prognosis, but the development of drug resistance reduces the success rate of treatment. Understanding the mechanism of drug resistance and the characteristics of pathogens can provide targets for the research of new drugs, but there is no new drug that can be applied to clinical patients. Therefore, re-exploring the therapeutic effect of existing drugs can be used as one of the treatment options. This article summarizes the guideline basic drugs for NTM pulmonary disease caused by the above three pathogens and the choice of treatment options after drug resistance.

Key words： Nontuberculous mycobacteria Treatment Drug resistance Human immuno-deficiency virus

基金资助:国家自然科学基金资助项目（81873761）；
国家“十三五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项（2018ZX10302104-001-003）。

通讯作者: ▲通讯作者

引用本文:

魏华英杨洋仵永枫画伟张玉林▲. 耐药非结核分枝杆菌肺部疾病治疗进展[J]. 中国医药导报, 2020, 17(34): 52-55.
WEI Huaying YANG Yang WU Yongfeng HUA Wei ZHANG Yulin▲. Progress in the treatment of drug-resistant nontuberculous mycobacteria in pulmonary disease. 中国医药导报, 2020, 17(34): 52-55.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I34/52

[1] 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.
[2] 王宇.全国第五次结核病流行病学抽样调查资料汇编[M].北京：军事医学科学出版社出版，2011.
[3] Morimoto K，Iwai K，Uchimura K，et al. A steady increase in nontuberculous mycobacteriosis mortality and estimated prevalence in Japan [J]. Ann Am Thorac Soc，2014，11（1）：1-8.
[4] Griffith DE，Aksamit T，Brown-Elliott BA，et al. An Official ATS/IDSA Statement：Diagnosis，Treatment，and Prevention of Nontuberculous Mycobacterial Diseases [J]. Am J Respir Crit Care Med，2007，175（4）：367-416.
[5] Kobashi Y，Matsushima T，Oka M. A double-blind randomized study of aminoglycoside infusion with combined therapy for pulmonary Mycobacterium avium complex disease [J]. Respir Med，2007，101（1）：130-138.
[6] Kim SY，Han SA，Kim DH，et al. Nontuberculous mycobacterial lung disease：ecology，microbiology，pathogenesis，and antibiotic resistance mechanisms [J]. Precision and Future Medicine，2017，1（3）：99-114.
[7] Morimoto K，Namkoong H，Hasegawa N，et al. Macrolide-Resistant Mycobacterium avium Complex Lung Disease：Analysis of 102 Consecutive Cases [J]. Ann Am Thorac Soc，2016，13（11）：1904-1911.
[8] Griffith DE，Brown-Elliott BA，Langsjoen B，et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease [J]. Am J Respir Crit Care Med，2006，174（8）：928-934.
[9] Hagerman JK，Hancock KE，Klepser ME. Aerosolised antibiotics：a critical appraisal of their use [J]. Expert Opin Drug Deliv，2006，3（1）：71-86.
[10] Griffith DE，Eagle G，Thomson R，et al. Amikacin Liposome Inhalation Suspension for Treatment-Refractory Lung Disease Caused by Mycobacterium avium Complex（CONVERT）. A Prospective，Open-Label，Randomized Study [J]. Am J Respir Crit Care Med，2018，198（12）：1559-1569.
[11] Martiniano SL，Wagner BD，Levin A，et al. Safety and Effectiveness of Clofazimine for Primary and Refractory Nontuberculous Mycobacterial Infection [J]. Chest，2017， 152（4）：800-809.
[12] Jarand J，Davis JP，Cowie RL，et al. Long-term Follow-up of Mycobacterium avium Complex Lung Disease in Patients Treated With Regimens Including Clofazimine and/or Rifampin [J]. Chest，2016，149（5）：1285-1293.
[13] Ferro BE，Meletiadis J，Wattenberg M，et al. Clofazimine Prevents the Regrowth of Mycobacterium abscessus and Mycobacterium avium Type Strains Exposed to Amikacin and Clarithromycin [J]. Antimicrob Agents Chemother，2016，60（2）：1097-1105.
[14] Lawn SD，Bekker LG，Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals [J]. Lancet Infect Dis，2005，5（6）：361-373.
[15] Phillips P，Bonner S，Gataric N，et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients：spectrum of disease and long-term follow-up [J]. Clin Infect Dis，2005，41（10）：1483-1497.
[16] Chaisson RE，Keiser P，Pierce M，et al. Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic Mycobacterium avium complex disease in patients with HIV infection [J]. Aids，1997，11（3）：311-317.
[17] Johnston JC，Chiang L，Elwood K. Mycobacterium kansasii [J]. Microbiol Spectr，2017，5（1）：725-734.
[18] Wallace Jr RJ, Dunbar D, Brown B A, et al. Rifampin-resistant Mycobacterium kansasii [J]. Clin Infect Dis，1994，18（5）：736-743.
[19] Philley JV，Griffith DE. Treatment of slowly growing mycobacteria [J]. Clin Chest Med，2015，36（1）：79-90.
[20] Griffith DE，Brown-Elliott BA，Wallace Jr RJ. Thrice-weekly clarithromycin-containing regimen for treatment of Mycobacterium kansasii lung disease：results of a preliminary study [J]. Clin Infect Dis，2003，37（9）：1178-1182.
[21] Shitrit D，Peled N，Bishara J，et al. Clinical and radiological features of Mycobacterium kansasii infection and Mycobacterium simiae infection [J]. Respir Med，2008， 102（11）：1598-1603.
[22] Moon SM，Choe J，Jhun BW，et al. Treatment with a macrolide-containing regimen for Mycobacterium kansasii pulmonary disease [J]. Respir Med，2019，148：37-42.
[23] 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.
[24] Marras TK，Daley CL. A systematic review of the clinical significance of pulmonary Mycobacterium kansasii isolates in HIV infection [J]. J Acquir Immune Defic Syndr，2004，36（4）：883-889.
[25] Adjemian J，Frankland TB，Daida YG，et al. Epidemiology of Nontuberculous Mycobacterial Lung Disease and Tuberculosis，Hawaii，USA [J]. Emerg Infect Dis，2017， 23（3）：439-447.
[26] Jhun BW，Yang B，Moon SM，et al. Amikacin Inhalation as Salvage Therapy for Refractory Nontuberculous Mycobacterial Lung Disease [J]. Antimicrob Agents Chemother，2018，62（7）.
[27] Yang B，Jhun BW，Moon SM，et al. Clofazimine-Containing Regimen for the Treatment of Mycobacterium abscessus Lung Disease [J]. Antimicrob Agents Chemother，2017，61（6）：e02052-16.
[28] Koh WJ，Jeong BH，Jeon K，et al. Oral Macrolide Therapy Following Short-term Combination Antibiotic Treatment of Mycobacterium massiliense Lung Disease [J]. Chest，2016，150（6）：1211-1221.
[29] Brown-Elliott BA，Philley JV，Griffith DE，et al. In Vitro Susceptibility Testing of Bedaquiline against Mycobacterium avium Complex [J]. Antimicrob Agents Chemother，2017，61（2）：e01798-16.
[30] Ruth MM，Sangen JJN，Remmers K，et al. A bedaquiline/clofazimine combination regimen might add activity to the treatment of clinically relevant non-tuberculous mycobacteria [J]. J Antimicrob Chemother，2019，74（4）：935-943.
[31] Philley JV，Wallace Jr RJ，Benwill JL，et al. Preliminary Results of Bedaquiline as Salvage Therapy for Patients With Nontuberculous Mycobacterial Lung Disease [J]. Chest，2015，148（2）：499-506.
[32] Obregon-Henao A，Arnett KA，Henao-Tamayo M，et al. Susceptibility of Mycobacterium abscessus to antimycobacterial drugs in preclinical models [J]. Antimicrob Agents Chemother，2015，59（11）：6904-6912.
[33] Van Bambeke F，Barcia-Macay M，Lemaire S，et al. Cellular pharmacodynamics and pharmacokinetics of antibiotics：current views and perspectives [J]. Curr Opin Drug Discov Devel，2006，9（2）：218-230.
[34] Aung TT，Yam JK，Lin S，et al. Biofilms of Pathogenic Nontuberculous Mycobacteria Targeted by New Therapeutic Approaches [J]. Antimicrob Agents Chemother，2016，60（1）：24-35.