儿童非结核分枝杆菌感染研究进展

Research Progress on Nontuberculous Mycobacterial Infections in Children

摘要: 近年来，非结核分枝杆菌(NTM)感染的发病率在全球范围内呈显著上升趋势，尤其在免疫功能低下及老年人群中更为突出，已成为日益严峻的临床与公共卫生挑战。本文系统综述了NTM感染在流行病学、致病与易感机制、临床表现、实验室辅助检查及治疗等方面的最新研究进展。NTM的发病主要由“病原体毒力、宿主免疫与环境暴露”三者共同驱动。其临床表现呈高度多样化且缺乏特异性，成人多见肺部疾病，儿童多见淋巴结等肺外感染，而免疫抑制人群极易发展为播散性感染。在诊断方面，传统培养虽为金标准，但高通量测序、质谱分析等分子生物学技术的普及显著提升了菌种鉴定的时效与精准度。鉴于NTM复杂的天然耐药及诱导耐药机制，治疗上必须依赖精准的菌种(亚种)鉴定及药敏结果，采取长疗程、个体化的多药联合方案。未来，进一步探索新型靶向抗菌药物与免疫干预手段，将是破解NTM难治性僵局、改善患者预后的关键。

Abstract: In recent years, the global incidence of nontuberculous mycobacterial (NTM) infections has risen markedly, with particularly pronounced increases among immunocompromised and older populations, making NTM an increasingly serious clinical and public health challenge. This article provides a systematic review of the latest research advances in NTM infection, covering epidemiology, mechanisms of pathogenesis and host susceptibility, clinical manifestations, laboratory and ancillary diagnostic testing, and treatment strategies. The occurrence of NTM disease is primarily driven by the combined effects of mycobacterial virulence, host immune status, and environmental exposure. Clinical presentations are highly heterogeneous and largely nonspecific: pulmonary disease predominates in adults, whereas children more commonly develop extrapulmonary infections such as lymphadenitis; immunosuppressed individuals are at high risk of progressing to disseminated disease. For diagnosis, although conventional culture remains the gold standard, the broader adoption of molecular approaches—such as high-throughput sequencing and mass spectrometry—has substantially improved the timeliness and accuracy of species identification. Given the complex intrinsic and inducible drug-resistance mechanisms of NTM, effective therapy must rely on precise species (and subspecies) identification and drug-susceptibility testing, with prolonged, individualized multi-drug combination regimens. Looking ahead, further exploration of novel targeted antimicrobials and immunomodulatory interventions will be crucial to overcoming the therapeutic impasse posed by difficult-to-treat NTM disease and to improving patient outcomes.