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Objective To compare the clinical features of pulmonary infections with Mycobacterium intracellulare and Mycobacterium abscessus in the tuberculosis intensive care unit (ICU).Methods Clinical data of 74 patients with non-tuberculous mycobacterial pulmonary infection (NTM) admitted in tuberculosis ICU of Hangzhou Red Cross Hospital from January 2012 to May 2017 were retrospectively analyzed.There were 54 patients infected with Mycobacterial abscesses, 16 patients with Mycobacterial intracellular, 2 patients with Mycobacterium avium and 2 patients with Mycobacterium kansasii.The clinical features, imaging manifestations, treatment and prognosis of patients with Mycobacterial intracellular and Mycobacterial abscesses lung infections were compared.SPSS 21.0 software was used for statistical analysis.Survival curve analysis was performed using GraphPad Prism V 5.01.Results Among 74 patients with NTM lung disease , the infection rate of Mycobacterium abscessus was 72.87%(54/74), and the infection rate of Mycobacterium intracellular was 21.62%( 16/74 ).The age of patients with Mycobacterium intracellularis pulmonary disease was younger and the length of ICU stay was shorter than those of patients with Mycobacterium abscessus (t＝－2.729 and －6.150, P＜0.05 or ＜0.01).There was no significant difference in the gender distribution and APACHE Ⅱ scores between the two groups ( both P＞0.05).The proportion of patients with chronic obstructive pulmonary disease ( COPD) in Mycobacterium intracellularis group was significantly lower and the proportion of patients with bronchiectasis was significantly higher than those in Mycobacterial abscesses group (χ2＝3.902, P＜0.05; χ2＝23.888, P＜0.01).The proportion of patients complicated with stroke sequelae , Parkinson's disease and other central nervous system diseases ( χ2＝14.872, P＜0.01) and diabetes (χ2＝3.902, P＜0.05) in Mycobacterial abscess group was significantly higher, and that of hemoptysis was significantly lower (χ2＝9.717, P＜0.01) than those in Mycobacterium intracellularis group.Respiratory failure (93.75%) and septic shock (6.25%) were the main reasons of ICU admission for patients with Mycobacterium intracellularis lung disease; while respiratory failure (90.74%), heart failure (11.11%) and renal failure (1.85%) were main reasons of ICU admission for patients with Mycobacterial abscesses; there were no significant differences in the causes of ICU admission between the two groups ( all P＞0.05).The proportion of NTM isolated from patients with Mycobacterial intracellular lung disease, prior to mechanical ventilation was significantly higher than that of patients with Mycobacterial abscess ( χ2＝30.366, P ＜0.01 ).In imaging, the proportion of bronchiectasis in Mycobacterium intracellularis lung disease group was significantly higher than that in Mycobacterial abscesses lung disease group (χ2＝23.888, P＜0.01).There was no significant difference in the 28-day mortality rate between the two groups (χ2＝3.244, P＞0.05), while the survival rate in patients with Mycobacterium intracellularis lung disease within 120 days was significantly higher than that in patients with Mycobacterial abscesses lung disease (χ2＝12.780, P＜0.01).Conclusion When critically ill patients are positive for acid-fast staining, the ICU physician should consider the possibility of NTM lung disease.For severe patients with long-term mechanical ventilation , Mycobacterium abscessus infection should be considered first.
RESUMO
Objective To evaluate the effects of enteral immunonutrition on cell immunity level and clinical efficacy in patients with severe tuberculosis. Methods Sixty patients with severe tuberculosis were admitted to the department of tuberculosis intensive care unit of Hangzhou Red Cross Hospital from June 2015 to June 2017, and they were randomly divided into a conventional enteral nutrition group (EN group) and a enteral immunonutrition group (EIN group), each group 30 cases. Based on the patients' gastrointestinal tolerance condition, the EN group was treated with therapies of normal nutrition support, anti-tuberculosis, anti-infection, etc.; the EIN group was treated with enteral immunonutrition (TPF-T), and simultaneously with anti-tuberculosis, anti-infection, etc. therapies according to the disease situation. The target energy maintained at 104.6 kJ·d-1·kg-1and the therapeutic course was 14 days in the two groups. The levels of interleukins (IL-6, IL-10) and interferon-γ (IFN-γ), white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), cell immune indexes (T cell subgroup CD4+, CD8+) were observed before treatment and on day 14 after treatment in the patients of two groups; the changes of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment and after treatment and 28-day mortality rate were recorded in the two groups. Results After treatment, the levels of WBC, CRP, PCT were obviously lower than those before treatment, while the levels of IL-6, IFN-γ, CD4+in the two groups were significantly higher than those before treatment, and the changes of the EIN group were more significant than those in the EN group [WBC (×109/L): 8.0±3.1 vs. 10.0±2.4, CRP (mg/L): 30.3±9.1 vs. 45.8±6.6, PCT (μg/L): 2.2±1.8 vs. 4.3±2.2, IL-6 (mg/L): 182.53±8.52 vs. 168.42±7.62, IFN-γ (mg/L): 32.52±3.5 vs. 25.41±2.6, CD4+: 0.56±0.06 vs. 0.45±0.08, all P < 0.05]. The level of CD8+after treatment in the two groups was higher than that before treatment (the EN group: 0.28±0.06 vs. 0.27±0.07, the EIN group: 0.27±0.08 vs. 0.26±0.09), the APACHE Ⅱ scores in the two groups were lower than those before treatment (the EN group: 11±6 vs. 18±4, the EIN group: 10±3 vs. 17±6), the 28-day mortality in the EIN group was lower than that in the EN group [13.3% (4/30) vs. 16.7% (5/30)], no statistical significant difference in CD8+, APACHE Ⅱscore, 28-day mortality between the two groups being found (all P > 0.05). Conclusion Enteral immunonutrition can improve the level of cell immunity and decrease the degree of inflammatory response, and increase the clinical curative effect in patients with severe tuberculosis.