结核后非结核分枝杆菌肺病的流行病学及诊疗新进展

doi:10.19871/j.cnki.xfcrbzz.2026.03.015

摘要/Abstract

摘要： 全球结核病幸存者群体扩大,结核后非结核分枝杆菌肺病（post-tuberculous nontuberculous mycobacterial pulmonary disease,post-TB NTM-PD）已成为重要的公共卫生挑战。本文将“结核后”定义为肺结核经规范治疗痊愈或失败后,患者因肺部结构与免疫残留损伤继发NTM肺部感染的状态。全球NTM-PD发病率持续上升,与结核病发病率下降形成对比;我国该病呈东北、东南沿海高发的地理分布特征,优势致病菌为鸟-胞内分枝杆菌复合群（mycobacterium avium-intracellulare complex,MAC）与脓肿分枝杆菌复合群（mycobacterium abscessus complex,MABC）。该病发病机制与结核所致肺部结构损伤、局部免疫失调密切相关,且临床表现与结核病复发高度重叠,易引发临床诊断延迟、误诊和漏诊。本文系统综述其流行病学特征与发病机制,重点阐述高分辨率CT影像组学、宏基因组二代测序、质谱技术在精准鉴别诊断中的应用价值;治疗方面,除基于菌种鉴定和药物敏感试验的个体化规范化多药联合方案外,还深入探讨吸入性脂质体阿米卡星等新型药物的应用,并评估外科手术的适应证与疗效。最后强调多学科综合管理对改善患者预后的重要性,同时指出分子诊断普及等临床现存挑战,为临床医师提升post-TB NTM-PD早期识别能力、优化诊疗策略提供参考。

关键词: 结核后非结核分枝杆菌肺病, 影像学鉴别, 分子诊断, 综合治疗

Abstract: ObjectiveWith the global expansion of the tuberculosis survivor population, post-tuberculous nontuberculous mycobacterial pulmonary disease (post-TB NTM-PD) has become a severe public health challenge. "Post-tuberculous" is defined as a state of secondary NTM pulmonary infection caused by residual pulmonary structural and immune damage after standardized anti-tuberculosis treatment with cure or failure. The global incidence of NTM-PD is rising steadily, in sharp contrast to the declining tuberculosis incidence. In China, NTM-PD shows high prevalence in northeastern and southeastern coastal areas with distinct geographic heterogeneity, and the predominant pathogens are Mycobacterium avium-intracellulare complex (MAC) and Mycobacterium abscessus complex (MABC). Its pathogenesis is associated with residual pulmonary structural damage, local immune dysfunction and NTM biofilm formation. Due to high clinical overlap with tuberculosis recurrence, delayed diagnosis, misdiagnosis and missed diagnosis are prominent, with a median diagnosis time of 21.2 months for delayed patients. This paper reviews its epidemiological characteristics and pathogenesis, and focuses on the application value of HRCT radiomics, mNGS and MALDI-TOF MS in accurate differential diagnosis. In terms of treatment, besides individualized multi-drug combination regimens based on species identification and drug susceptibility testing, it explores the application of novel drugs such as inhaled liposomal amikacin (ALIS) and bedaquiline in refractory cases, and evaluates surgical indications and efficacy. Finally, it emphasizes the importance of multidisciplinary comprehensive management for improving prognosis, and points out the existing challenges such as the popularization of molecular diagnosis. By systematically reviewing the research advances and existing challenges in this field, this review aims to provide a reference for clinicians to enhance early recognition of post-TB NTM-PD and optimize diagnostic and treatment strategies, as well as to identify future research directions.

Key words: Post-tuberculous nontuberculous mycobacterial pulmonary disease, Imaging differentiation, Molecular diagnosis, Comprehensive therapy

中图分类号:

R521
R378.91

赖晓宇, 陈珣珣, 廖庆华, 温文沛, 吴粤. 结核后非结核分枝杆菌肺病的流行病学及诊疗新进展[J]. 新发传染病电子杂志, 2026, 11(3): 81-88.

Lai Xiaoyu, Chen Xunxun, Liao Qinghua, Wen Wenpei, Wu Yue. Post-tuberculosis nontuberculous mycobacterial pulmonary disease: epidemiology and latest advances in diagnosis and treatment[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 81-88.

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