CHEST Jeffrey Glassroth, MD, FCCP (NTM) HIV NTM NTM NTM γ 3 COPD 3NTM 1 NTM CT (bronchiectasis); (hypersensitivity pneumonitis); (Mycobacterium avium complex); (Mycobacterium kansasii); (nontuberculous mycobacteria); (pulmonary disease); (rapidly growing mycobacteria) HRCT = high-resolution CT; IFN = interferon; IGRA = interferon-γ release assay; IL = interleukin; MAC = Mycobacterium avium complex; NTM = nontuberculous mycobacteria; RGM = rapidly growing mycobacteria; TNF = tumor necrosis factor [1] 327
(NTM) NTM NTM NTM ( ) ( MAC) ( ) NTM NTM [2] NTM NTM NTM NTM NTM NTM NTM 1979 1980 32 000 From Feinberg School of Medicine, Northwestern University, Chicago, IL. Correspondence to: Jeffrey Glassroth, MD, FCCP, Feinberg School of Medicine, Northwestern University, Ward 4-009, 303 E Chicago Ave, Chicago, IL 60611; e-mail: j- glassroth@northwestern.edu 1/3 [3] 1992 33 3 /4 [4] MAC (RGM) [5 6] HIV NTM 0.73 / 100 000 MAC RGM [7] [8 9] / NTM HIVNTM [10] NTM CT NTM ( ) ( COPD ) [11] NTM [12] ph / (IL) 8 IL-12 RANTES ( T ) 1 [13] IL-10 (TNF) α / ( ) [14] [15] γ TNF CD4 T IL-2 IFN-γ TNF-γ [16] [12] 328
HIV CD4 [17] IFN-γ [18] IFN-γ [19] NTM RGM [12] NTM [20] IFN-γ NTM MAC NTM 3 [21] COPD [22] 1 1 25 HRCT [23] [24 25] [26] RGM 1 MAC 3 NTM [27] NTM [28] [29] [30,31] NTM ( ) NTM [34] NTM NTM NTM HIV HIV NTM HIV CD4 [32] ( 50% ) [10 25] NTM COPD [11] [33] [23] NTM 329
NTM NTM [35,36] NTM NTM IFN-γ (IGRA) NTM [37] IGRA NTM CT NTM Jeong [38] 22 NTM CT (HRCT) NTM HRCT ( 1) NTM HRCT [38] [35 39 40] Koh [41] HRCT 1/3 NTM NTM NTM (Lady Windermere syndrome) [42] MAC NTM NTM [28] [26] [43] HIV NTM [44] ( ) [45] [42] [46] [47] [48] RGM [49] 1 NTM (1) NTM (2) (3) HRCT ( ) (1 y ) 2 2 (4) / 1 1 (5) ( ) NTM / 1 1 NTM (1) NTM [10] (2) NTM (3) (4) 3 (5) () 330
2 NTM (1) NTM ( ) 1 ( 3 ) 1 2 ( / / 4 ( ) ( / ) 3 COPD 1 ( ) / ( 3 6 mo) () ( ) 3 6 mo () () NTM ; 1 2 () 1 ( ) 2 ( ) (1) = / = NTM NTM 6500 [50] NTM 60% NTM RGM NTM NTM NTM [51 52] 331
NTM Bactec (Becton Dickinson Sparks MD) NTM [10] RNA (Accu Probe GeneProbe San Diego CA) NTM MAC ( ) DNA (Amplicor test Roche Molecular Systems Branchburg NJ) ( ) [51] 16 S RNA [52] [53] NTM NTM NTM ( 100) ( ) (2) NTM [54] ( 1) NTM ( ) [10] Bailey [55] MAC NTM NTM 12 mo MAC [10] ( 2) NTM [56] MAC [8] HIV MAC [57] 3 NTM / 50 8 25 mg / kg 3 500 mg 8 25 mg / kg IV 3 15 mg / kg / d 25 mg / kg 3 25 mg / kg / d 300 mg / d 900 mg / d B6 ( ) [10] 50 kg 500 1 000mg/d 1000 mg 3 70 250 300 mg / d 500 600 mg 3 50 mg 450 600 mg / d 600 mg 3 150 300 mg / d 300 mg 3 332
NTM NTM [58] NTM (3 6mo) [10] [59 60] [61 62] [63] 3 2mo (25 mg / kg) 15 mg / kg ( 3) 12 mo [10] [64] 0.5 1.0 g IV 3 2 3mo NTM HIV [63] (15 mg / kg) 9 mo 100% 5y 10% 18 ( 500 1 000 mg) (600 mg) ( 25 mg / kg) 3 13 mo 46 mo [65] 3 4 MAC MAC 5y 30% 36% [66] Wallace [67] ( ) ( 5 ) MAC 1y 12 mo 2317.8 mo 19.1 mo [68 70] 60% 100% 50% 82% [70] ( ) [70] [50] 250 300 mg 3 500 600 mg [71] 3 MAC COPD [72] [7] MAC [73] MAC 333
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