实用医学杂志 ›› 2022, Vol. 38 ›› Issue (17): 2191-2197.doi: 10.3969/j.issn.1006⁃5725.2022.17.014

• 临床研究 • 上一篇    下一篇

广州地区2018⁃2021年非结核分枝杆菌临床分离株菌种鉴定结果分析

陈华1 赖晓宇2 陈品儒1 胡锦兴1 邓政先1 许柳清1 梁锋1   

  1.  1 广州市胸科医院内一科(广州 510095);2 广东省结核病控制中心(广州 510630)

  • 出版日期:2022-09-10 发布日期:2022-09-10
  • 通讯作者: 赖晓宇 E⁃mail:871995770@qq.com;陈品儒 E⁃mail:chenpinru1965@126.com
  • 基金资助:
    广东省医学科学技术研究基金项目(编号:C2021090)

Analysis of the identification results of non ⁃ tuberculous clinical isolates of mycobacterium tuberculosis in Guangzhou from 2018 to 2021

CHEN Hua*,LAI Xiaoyu,CHEN Pinru,HU Jinxing,DENG Zhengxian,XU Liuqing,LIANG Feng.    

  1. Department of Internal Medicine,Guangzhou Chest Hospital,Guangzhou 510095,China

  • Online:2022-09-10 Published:2022-09-10
  • Contact: LAI Xiaoyu E⁃mail:871995770@qq.com;CHEN Pinru E⁃mail:chenpinru1965@126.com

摘要:

目的 分析广州地区非结核分枝杆菌(NTM)的菌种分布及 NTM 肺病(NTM⁃PD)状况变化, NTM⁃PD 的防治提供参考依据。方法 收集 2018⁃2021 年广州市胸科医院住院及门诊就诊患者的痰液、 支气管冲洗液、脓液、尿液、浆膜腔积液、脑脊液和穿刺物等分枝杆菌培养阳性(BACTEC MGIT 960 和改良 罗氏法)的标本,对培养物阳性分枝杆菌菌株 18 501 株进行菌群鉴定,将所有鉴定为 NTM 的菌株用 16S rRNA 基因测序方法进行菌种鉴定,剔除重复后的菌株共检出 NTM 6 558 株。对 NTM 菌种来源、菌种分 布、性别、年龄等不同特征进行分析。结果采用 SPSS 23.0 统计学软件进行统计分析。率的比较采用 χ2 验,以 P < 0.05 为差异有统计学意义。结果 2018-2021 年各种标本培养分枝杆菌阳性的 18 501 株,采用 基因芯片法进行菌种鉴定,NTM 检出率为 35.45%(6 558/18 501),其中痰与支气管冲洗液的总检出率为 36.67%(6 426/17 522);6 558 NTM(按年度剔除重复病例计算)共来自于 4 336 例患者,各年间 NTM 离率分别为 28.01%、29.04%、29.63%、31.68%;四年间总的病例数 3 624 例,NTM 感染患者分离率 27.98% (3 624/12 950);前5位菌种分布为:MAC 1 305例(36.01%)、龟-脓肿分枝杆菌复合群 1 240例(34.22%)、堪萨 斯分枝杆菌 286 例(7.89%)、偶发分枝杆菌 285 例(7.86%)、戈登分枝杆菌 137 例(3.78%)。男女性别比为 1∶139(1 694∶1 930),高峰年龄段均为 51 ~ 70 岁(占 46.36%)。结论 广州地区近年来 NTM 检出率呈逐年 上升趋势,菌种分布种类多样,流行的菌种以鸟⁃胞内分枝杆菌和龟-脓肿分枝杆菌为主的稳定状态,中老 年患者易感,女性人群应重点关注、探讨更适用于临床常规使用的菌种鉴定技术是目前提高精确诊断的 重要环节。

关键词:

分枝杆菌, 非典型性, 菌种, 流行病学研究, -胞内分枝杆菌复合群, -脓肿 分枝杆菌复合群

Abstract:

Objective The distribution of non ⁃tuberculous mycobacteria(NTM)and the changes in the status of NTM lung disease(NTM⁃PD)in Guangzhou were analyzed in order to provide a reference for the preven⁃ tion and treatment of NTM⁃PD. Methods Specimens of positive cultures of mycobacteria such as sputum,bronchial irrigation fluid,pus,urine,serous effusion,cerebrospinal fluid and puncture in inpatient and outpatient patients of Guangzhou Chest Hospital from 2018 to 2021 were collected,and 18 501 strains of culture⁃positive Mycobacterium strains were identified by 16S rRNA gene sequencing method. Different characteristics such as NTM strain source strain distribution,sex,age and so on were analyzed. The results were statistically analyzed using SPSS 23.0 statis⁃ tics software. The comparison of the rates was measured by x2,and the difference between P < 0.05 was statistically significant. Results From 2018 to 2021,a total of 18 501 strains of mycobacteria positive in various specimens were identified by gene chip method,and the NTM detection rate was 35.45%(6 558/18 501),of which the total detection rate of sputum and bronchial irrigation solution was 36.67%(6 426/17 522);6 558 strains of NTM (calculated by annual elimination of repeated cases)came from 4 336 patients,and the NTM isolation rates were 28.01%,29.04%,respectively. 29.63%,31.68%;The total number of cases in the four years(deleting inter⁃ annual recurrence)was 3 624,the isolation rate of NTM infected patients was 27.98%(3 624/12 950);the distri⁃bution of the top 5 species was:MAC 1305 cases(36.01%),turtle ⁃abscess mycobacterium complex group 1240 cases(34.22%),Mycobacterium Kansas 286 cases(7.89%),occasional mycobacteria 285 cases(7.86%),There were 137 cases of Mycobacterium Gordon(3.78%). The sex ratio of men to women was 1∶139(1 694∶1 930),and the peak age group was 51⁃70 years old(46.36%). Conclusion In recent years,the detection rate of NTM in Guangzhou has shown an upward trend year by year,the distribution of strains was diverse,the popular strains were mainly stable states of bird⁃intracellular mycobacteria and mycobacterium turtle⁃abscess;middle⁃aged and elderly patients werethe susceptible population,and the female population should be also paid attention to. Finding a more suitable strain identification technology for routine clinical use is the focus of improving accurate diagnosis at present.

Key words:

mycobacterium, atypical, strains, epidemiological studies, ornithus ? intracellular mycobacterium complex, turtle?abscess mycobacterium complex