实用医学杂志 ›› 2023, Vol. 39 ›› Issue (11): 1347-1352.doi: 10.3969/j.issn.1006⁃5725.2023.11.005

• 专题报道 • 上一篇    下一篇

广州地区鸟分枝杆菌和胞内分枝杆菌耐药性与临床预后的相关性 

何湘容1 张天宇2 王歆雨1 刘志辉3,4 王琪3,4 苏宁3,4 胡锦兴3,4    

  1. 1 广州医科大学研究生院(广州 511436);2 中国科学院广州生物医药与健康研究院(广州 510530); 3 呼吸疾病国家重点实验室(广州 510182);4 广州市胸科医院(广州 510095)
  • 出版日期:2023-06-10 发布日期:2023-06-10
  • 通讯作者: 胡锦兴 E⁃mail: hujinxing2000@163.com
  • 基金资助:
    国家重点研发计划(编号:2022YFC2304800);广州 市重点研发计划(编号:202206010061);广州市科技计划项目(编 号:201904010071)

Correlation between drug resistance of Mycobacterium avium and Mycobacterium intracellulare and clinical prognosis in Guangzhou

HE Xiangrong*,ZHANG Tianyu,WANG Xinyu,LIU Zhihui,WANG Qi,SU Ning, HU Jinxing.    

  1. Graduate School of Guangzhou Medical University,Guangzhou 511436,China 
  • Online:2023-06-10 Published:2023-06-10
  • Contact: HU Jinxing E⁃mail:hujinxing2000@163.com

摘要:

目的 明确广州地区鸟分枝杆菌复合群(MAC)不同菌种及药物敏感性与临床预后的关系。方法 收集 2018⁃2020 年广州地区分枝杆菌菌株库保藏的 MAC 临床分离菌株,对临床资料齐全并确 诊为 MAC 肺病患者的临床菌株进行 16S rRNA、ITS、rpoB、hsp65 多靶位基因测序将其鉴定至种,再应用微 孔板法测定最低抑菌浓度确定其药物敏感性;根据患者临床症状、DR/CT 影像学检查以及病原菌培养结 果判断其临床治疗是否成功。结果 (1)91 株 MAC 临床分离菌株中胞内分枝杆菌 63 株(69.23%),鸟分枝 杆菌 21 株(23.07%);(2)鸟分枝杆菌和胞内分枝杆菌对阿米卡星、乙胺丁醇的耐药率存在差异(P < 0.05); (3)鸟分枝杆菌肺病和胞内分枝杆菌肺病的治疗成功率存在显著差异(66.67% vs. 41.27%,χ2 = 6.053,P < 0.05)。结论 广州地区 MAC 临床分离菌株以胞内分枝杆菌和鸟分枝杆菌为主,不同 MAC 菌种的耐药性 及临床预后存在差异;对于 NTM 肺病患者,应对其进行菌种鉴定和体外药敏试验,并根据上述结果制定并优化临床治疗方案。

关键词: 鸟分枝杆菌复合群, 鸟分枝杆菌, 胞内分枝杆菌, 药物敏感性试验, 临床预后

Abstract:

Objective To clarify the relationship between different species of Mycobacterium avium complex(MAC),drug sensitivity and clinical prognosis in Guangzhou. Methods The clinical isolates of MAC from 2018 to 2020 were collected from the Mycobacterium Strain Bank in Guangzhou,and the MAC strains of MAC lung disease patients were sequenced to identify them by 16S rRNA,ITS,rpoB,hsp65 multi⁃target gene sequencing. MIC50 and MIC90 of its minimum inhibitory concentration(MIC)were determined by microplate method to deter⁃ mine its drug sensitivity. The success of clinical treatment can be judged according to the clinical symptoms,DR/ CT radiology and pathogen culture results. Results (1)There were 67 strains of Mycobacterium intracellulare (73.63%)and 21 strains of Mycobacterium avium(23.08%)in 91 clinical isolates of MAC.(2)The resistance rates of Mycobacterium avium and Mycobacterium intracellular to amikacin and ethambutol were different(P < 0.05).(3)There was significant difference in the treatment success rate between M.aviumpulmonary disease and M.intracellularepulmonary disease(66.67% vs. 41.27%,χ2 = 6.053,P < 0.05). Conclusion M.intracellulare and M.avium were the main clinical isolates of MAC in Guangzhou,and there were differences in drug resistance and clinical prognosis among different MAC species. For patients with NTM pulmonary disease,strain identification and in vitro drug susceptibility tests should be conducted,and clinical treatment protocols should be formulated and optimized based on the above results. 

Key words: Mycobacterium avium complex, Mycobacterium avium, Mycobacterium intracellulare, drug susceptibility test, clinical prognosis