2010-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660284摘要：非結核分枝桿菌 (Non-tuberculous Mycobacteria; NTM) 為廣泛存在於自然界中的分枝桿菌，一般被認為是低致病性病源。不過在免疫不全的患者，例如使用免疫抑制劑、罹患人類免疫缺乏病毒患者、以及慢性呼吸道疾病(慢性肺氣腫、塵肺病、慢性阻塞性肺病等)容易引起肺部、軟組織甚至瀰漫性感染。有另一群病人並無上述引起免疫不全的原因，卻發生瀰漫性非結合分枝桿菌感染，有些甚至併發伺機性感染 (如：沙門氏菌、隱孢球菌等等)。過去在台大醫院曾報導過十五例非愛滋病患罹瀰漫性非結核分枝桿菌感染個案，死亡率由12.5%至100%，隨感染菌種不同而異。之後又報導了六十三名軟組織感染非結合分枝桿菌的病患，其中只有30%可找出患者本身有免疫功能不全的原因(例如罹患人類免疫缺乏病毒患者或使用類固醇)，大部分原因仍然不明。目前已知部分原因不明的病患，經調查可發現他們與interferon-γ或interleukin-12相關的基因有缺陷，這些基因缺陷後造成巨細胞無法被interferon-γ所活化，使得巨細胞無法消滅所吞噬的細菌。近來在泰國患者的研究發現，部分患者體內產生中和interferon-γ自體抗體，使體內interferon-γ不足以活化巨細胞。此外，在痲瘋患者以及瀰漫性肺結核病患的研究中，發現一些特殊的人類白血球抗原與疾病嚴重度有關，這些白血球抗原與病源菌抗原表現有關聯，類似的研究在瀰漫性非結核分枝桿菌患者中並無進一步調查，本計劃預計針對在已知罹患瀰漫性非結核分枝桿菌患者中，調查自體抗體以及人類白血球抗原分布情形。<br> Abstract: Non-tuberculous mycobacteria (NTM) could cause opportunistic infections inimmunocompromised patients either innate or acquired. Mycobacterium marinum,rapidly growing mycobacteria (RGM), including M. fortuitum, M. chelonae and M.abscessus, and M. ulcerans were considered common aetiological species for skin andsoft tissue infections (SSTI), and M. avium complex (MAC), M. kansasii wereconsidered more common aetiological causes for pulmonary and disseminatedinfections. Diseases caused by NTM usually require prolonged medical treatment andeven surgical debridement. In some patients with disseminated NTM infection, noobvious causes of immonodeficiency such as human immunodeficiency virus infectionor immunosuppressant agents usage could be identified. Various studies havedemonstrated that defect in interferon-gamma (IFN-γ)/interleukin-12 pathway genescould be noted in these patients. Among these defects, autoantibodies to IFN-γ, havebeen reported in HIV-negative Thai patients who have disseminated or lymphaticnontuberculous infections. Hence, it is important to know whether these autoantibodiesalso exist in patients with disseminated NTM infection in Taiwan. Besides, specificHLA typing (HLA-DR2) has been noted to associate with developing lepromatousleprosy and disseminated tuberculosis infection. We propose to enroll non-HIV patientswho have been diagnosed with disseminated NTM infections to explore the presence ofautoantibodies and to examine potential genetic factors influencing the development ofthis disease. Plasma, cells, and DNA samples will be obtained and stored for analysis inthis study.agingdiabetesadvanced glycation end-productshyperglycemiaosteoarthritis