Objective: To explore the clinical characteristics of non-tuberculous mycobacterium(NTM) pulmonary disease complicated with tracheobronchial lesions. Methods: From January 2014 to December 2018, there were 1 006 patients who were admitted to Guangzhou Chest Hospital for the first time and received examination by bronchoscopy. A total of 89 patients with complete data were selected, including 40 males and 49 females, aged 20 to 85 years, with 46 patients (52%) aged 60 years or older. The clinical symptoms and signs of the patients were analyzed with chest imaging, bronchoscopy and pathological examination results. Comparisons between groups were made by Chi-square test and t test. Results: The number of patients with NTM complicated with tracheobronchial lesions accounted for 8.9%(89/1 006) of those hospitalized with NTM and received bronchoscopy during the same period. Clinical symptoms included cough and sputum (89/89), different degrees of hemoptysis or blood sputum (52/89), and shortness of breath (50/89). Chest CT showed that 72 cases (72/89, 81%) had lung lesions involving more than 3 lung fields, and 83 cases (93%) had bronchiectasis and 63 cases (63/89, 71%) with cavities. Pulmonary atelectasis was shown in 45 cases (45/89, 51%). By bronchoscopy, 39 cases (39/89, 44%) were diagnosed as tuberculous lesions involving bilateral upper bronchi, while lesions of the right lower bronchus was found in 27 cases (27/89, 30%).The percentage of patients with multilobar bronchial involvement was 50.6%(45/89). The morphological characteristics of the bronchial lesions included scar stenosis or atresia in 63 cases (63/89, 71%), hyperemia and edema in 46 cases (46/89, 52%), and multiple types of lesions in 48 cases (48/89, 54%). Conclusions: Patients with NTM lung disease complicated with tracheobronchial inflammatory lesions did not have specific manifestations clinically. Lung lesions are extensive, often accompanied by bronchiectasis and cavity formation. Endoscopic changes were mostly manifested as multilobar tracheobronchial involvement characterized by scar stenosis, congestion and edema, mainly involving bilateral upper bronchi and the right lower bronchus.
目的： 探讨非结核分枝杆菌（NTM）肺病合并气管支气管结核样病变的临床特点。 方法： 2014年1月至2018年12月首次在广州市胸科医院住院确诊并行支气管镜检查的患者1 006例，选取资料完整的NTM肺病合并气管支气管病变的患者89例，男性40例，女性49例，年龄20~85岁，中位年龄60(44，65）岁，60岁以上患者46例（52%)。对患者的临床症状、体征、影像学和支气管镜下的特点和病理学检查结果进行分析。组间比较采用χ²检验和t检验。 结果： NTM肺病并发支气管结核样病变的患者占同期住院治疗并行支气管镜检查NTM肺病患者的8.9%（89/1 006)。60岁以上患者46例（52%）。临床症状以咳嗽、咳痰（89/89)、不同程度的咯血或血痰（52/89）及气促（50/89）等为主；胸部CT提示肺部病灶累及3个以上肺野者72例（72/89，81%)，合并支气管扩张（83/89，93%）和肺空洞63例（63/89，71%)，肺不张或含气不全者45例（45/89，51%)。支气管镜检查支气管结核样病变主要累及双上支气管39例（39/89，44%)，右下支气管27例（27/89，30%)；多叶段支气管受累患者45例（45/89，51%）。气管支气管病变分型的特点：瘢痕狭窄或闭锁型63例（63/89，71%)，充血水肿型46例（46/89，52%)，多种类型并存48例（48/89，54%）。 结论： NTM肺病并发支气管结核样病变的患者临床表现无特异性。肺部病灶广泛，常伴支气管扩张、空洞形成。镜下改变主要累及双上支气管及右下支气管，以多叶段气管、支气管受累和混合类型表现多见；NTM支气管病变以瘢痕狭窄、充血水肿型为主要表现。.
Keywords: Bronchi; Infections; Lung; Mycobacterium.