绍兴地区非结核分枝杆菌肺部感染情况分析

doi:10.3969/j.issn.1673-8640.2020.02.007

摘要/Abstract

摘要：

目的了解绍兴地区由非结核分枝杆菌（NTM）所引起的肺部感染情况及细菌耐药状况,为临床合理用药提供参考。方法收集2017年7月—2018年7月分离自绍兴文理学院附属医院及各县区医院临床样本的NTM,并分析患者临床资料。采用对硝基苯甲酸培养基和噻吩-2-羧酸肼培养基对菌株进行初步鉴定,并用基因芯片技术进一步进行分型。采用比例法进行药物敏感性试验。结果 2 768例样本中共分离出NTM 243株,检出率为8.77%。NTM感染患者中男性占77.37%,<60岁者占65.43%,约70.00%的患者同时患有其他肺部疾病。243株NTM主要为胞内分枝杆菌（62.14%）,其次为鸟分枝杆菌（19.75%）。分离出的NTM对一线抗菌药物的耐药率均较高,对异烟肼和链霉素的耐药率近100.00%;对二线抗菌药物的耐药率低于一线抗菌药物。结论 NTM感染引起的肺部疾病好发于患有其他肺部疾病的患者,胞内分枝杆菌是临床主要的NTM,快速、准确地进行菌种鉴定有助于临床对患者进行早期诊断和治疗。

关键词: 非结核分枝杆菌, 肺部感染, 耐药性

Abstract:

Objective To investigate the status of lung infection caused by nontuberculous Mycobacterium（NTM） in Shaoxing and its drug resistance status,and to provide a reference on rational use of drugs. Methods NTM isolated from the specimens of patients in the Affiliated Hospital of Shaoxing University and county hospitals from July 2017 to July 2018 were collected and analyzed retrospectively. The isolates of NTM were identified by p-nitrobenzoic acid（PNB） and 2-thiophenecarboxylic acid hydrazide（TCH） media,which were further classified by gene chip. The drug susceptibility test was performed using proportion method. Results A total of 243 NTM were isolated,and the determination rate was 8.77%,which were mainly isolated from males（77.37%） and <60-year-old patients（65.43%）. About 70.00% of patients had other lung diseases. The NTM isolates were Mycobacterium intracellulare accounting for 62.14%,followed by Mycobacterium avium accounting for 19.75%. The drug resistance rate of NTM to first-line drugs was high,and the drug resistance rates to isoniazid and streptomycin were 100.00%. However,the drug resistance rate of NTM to second-line drugs was lower than that to first-line drugs. Conclusions Lung infection caused by NTM occurs in patients with other lung diseases. Mycobacterium intracellulare is the main pathogenic bacterium. Rapid and accurate identification is helpful for the early diagnosis and treatment of these patients.

Key words: Nontuberculous Mycobacterium, Lung infection, Drug resistance

中图分类号:

R446.1

赵金云, 金法祥, 许文芳, 许鹏, 童丹. 绍兴地区非结核分枝杆菌肺部感染情况分析[J]. 检验医学, 2020, 35(2): 125-128.

ZHAO Jinyun, JIN Faxiang, XU Wenfang, XU Peng, TONG Dan. Status analysis of lung infection caused by nontuberculous Mycobacterium in Shaoxing[J]. Laboratory Medicine, 2020, 35(2): 125-128.

图/表 3

参考文献 10

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临床特征	例数	百分比/%
性别
男性	188	77.37
女性	55	22.63
年龄
<60岁	159	65.43
≥60岁	84	34.57
基础疾病
慢性阻塞性肺疾病	61	25.10
支气管扩张	53	21.81
肺炎	40	16.46
糖尿病	27	11.11
乙型肝炎	11	4.53
肺结核	9	3.70
肺癌	6	2.47
获得性免疫缺陷综合征	3	1.23
囊性纤维化病	1	0.41
无	32	13.17

临床特征	例数	百分比/%
性别
男性	188	77.37
女性	55	22.63
年龄
<60岁	159	65.43
≥60岁	84	34.57
基础疾病
慢性阻塞性肺疾病	61	25.10
支气管扩张	53	21.81
肺炎	40	16.46
糖尿病	27	11.11
乙型肝炎	11	4.53
肺结核	9	3.70
肺癌	6	2.47
获得性免疫缺陷综合征	3	1.23
囊性纤维化病	1	0.41
无	32	13.17

细菌	株数	百分比/%
胞内分枝杆菌	151	62.14
鸟分枝杆菌	48	19.75
龟或脓肿分枝杆菌	21	8.64
堪萨斯分枝杆菌	16	6.58
瘰疬分枝杆菌	3	1.23
戈登分枝杆菌	2	0.82
偶然分枝杆菌	1	0.41
蟾蜍分枝杆菌	1	0.41

细菌	株数	百分比/%
胞内分枝杆菌	151	62.14
鸟分枝杆菌	48	19.75
龟或脓肿分枝杆菌	21	8.64
堪萨斯分枝杆菌	16	6.58
瘰疬分枝杆菌	3	1.23
戈登分枝杆菌	2	0.82
偶然分枝杆菌	1	0.41
蟾蜍分枝杆菌	1	0.41

细菌	株数		异烟肼		利福平		链霉素		乙胺丁醇
细菌	株数		耐药株数	耐药率/%	耐药株数	耐药率/%	耐药株数	耐药率/%	耐药株数	耐药率/%
胞内分枝杆菌	151		148	98.01	135	89.40	148	98.01	101	66.89
鸟分枝杆菌	48		47	97.92	46	95.83	47	97.92	30	62.50
龟或脓肿分枝杆菌	21		21	100.00	20	95.24	21	100.00	18	85.71
堪萨斯分枝杆菌	16		16	100.00	13	81.25	16	100.00	13	81.25
瘰疬分枝杆菌	3		3	100.00	3	100.00	3	100.00	3	100.00
戈登分枝杆菌	2		2	100.00	2	100.00	2	100.00	2	100.00
偶然分枝杆菌	1		1	100.00	1	100.00	1	100.00	1	100.00
蟾蜍分枝杆菌	1		1	100.00	1	100.00	1	100.00	1	100.00
细菌	对氨基水杨酸		卷曲霉素		卡那霉素		丙硫异烟肼		氧氟沙星
细菌	耐药株数	耐药率/%	耐药株数	耐药率/%	耐药株数	耐药率/%	耐药株数	耐药率/%	耐药株数	耐药率/%
胞内分枝杆菌	148	98.01	120	79.47	98	64.90	115	76.16	136	90.07
鸟分枝杆菌	47	97.92	36	75.00	29	60.42	36	75.00	44	91.67
龟或脓肿分枝杆菌	20	95.24	18	85.71	15	71.43	21	100.00	19	90.48
堪萨斯分枝杆菌	16	100.00	16	100.00	5	31.25	9	56.25	13	81.25
瘰疬分枝杆菌	3	100.00	3	100.00	3	100.00	3	100.00	3	100.00
戈登分枝杆菌	2	100.00	2	100.00	2	100.00	2	100.00	2	100.00
偶然分枝杆菌	1	100.00	1	100.00	1	100.00	1	100.00	1	100.00
蟾蜍分枝杆菌	1	100.00	1	100.00	1	100.00	1	100.00	1	100.00