2014至2016年温州地区呼吸道非结核分枝杆菌的流行状况分析  

Prevalence of nontuberculous mycobacteria isolated from pulmonary specimens in Wenzhou during 2014 to 2016

作　　者：何贵清 徐克 单志力[3] 施伎蝉 吴联朋 宁洪叶 崔小亚 吴正兴 郑庆勇 蒋贤高 He Guiqing Xu Ke Shan Zhili Shi Jichan Wu Lianpeng Ning Hongye Cui Xiaoya Wu Zhengxing Zheng Qingyong Jiang Xiangao(Department of Infectious Diseases Department of Clinical Laboratory Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China Institute of Tuberculosis, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000 ,Zhejiang Province, China)

机构地区：[1]浙江省温州市中心医院感染科,325000 [2]浙江省温州市中心医院检验科,325000 [3]浙江省温州市疾病预防控制中心结核病防治所,325000

出　　处：《中华临床感染病杂志》2017年第4期262-267,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：温州市科技计划项目（Y20140245）

摘　　要：目的 研究温州地区近三年呼吸道非结核分枝杆菌（NTM）的分离率、菌种分布及其变化趋势.方法 收集2014年1月至2016年12月疑似肺结核的患者,送检痰或肺泡灌洗液进行分枝杆菌培养,分枝杆菌阳性菌株进一步采用基因芯片、16S rRNA和hsp65基因测序进行菌种鉴定.采用SPSS 19.0软件对数据进行分析.结果 剔除重复菌株后,共分离3 295株,包括结核分枝杆菌复合群（MTB）3 032株、NTM 238株、戈登氏菌属20株、诺卡氏菌属3株和束村氏菌属2株.2014至2016年NTM占分枝杆菌构成比分别为8.5％ （86/1 006）、6.7％ （72/1 079）和6.8％ （80/1 185） （Х^2=2.459,P＞0.05）;NTM总分离率为7.3％ （238/3 270）,NTM菌种类别达15种,前三位菌种分别为胞内分枝杆菌（52.5％,125/238）、脓肿分枝杆菌（22.7％,54/238）和鸟分枝杆菌（10.1％,24/238）,其他NTM仅占14.7％（35/238）.鸟分枝杆菌从2014年的第五位上升至2016年的第二位（Х^2=18.259,P＜0.01）,而脓肿分枝杆菌占NTM构成比从2014年的34.9％（30/86）下降至2016年的17.5％ （14/80）（Х^2=7.335,P＜0.01）.分离出NTM的患者,男性占56.7％（135/238）,年龄＞45岁占79.8％ （190/238）.结论 近三年温州地区NTM分离率呈平稳趋势.菌种以胞内分枝杆菌、脓肿分枝杆菌和鸟分枝杆菌为主,鸟分枝杆菌分离呈持续上升趋势,而脓肿分枝杆菌分离出现下降趋势,值得临床医师关注.Objective To investigate the isolation rate, distribution and trend of nontuberculous mycobacteria （NTM） in Wenzhou during 2014 to 2016.Methods Sputum or alveolar lavage specimens of patients with suspected pulmonary tuberculosis were collected for mycobacteria culture from January 2014 to December 2016.Mycobacterium culture positive strains were further identified by gene chip, 16S rRNA and hsp65 gene sequencing.SPSS 19.0 software was used to analyze the data.Results After excluding repetitive strains, 3 295 mycobacteria strains （MTB） were isolated from respiratory specimens, included 3 032 mycobacterium tuberculosis complex strains, 238 NTM strains, 20 Gordon genera strains, 3 Nocardia genera strains and 2 Tsukamurella genera strains.The proportion of NTM among confirmed mycobacteria was 8.5% （86/1 006）, 6.7% （72/1 079） and 6.8% （80/1 185） in 2014, 2015 and 2016, respectively （Х^2 =2.459,P 〉 0.05）.The overall prevalence of NTM was 7.3 % （238/3 270）.There were 15 species of NTM, and the most common NTM strain was Mycobacterium intracellulare （52.5%,125/238）, followed by Mycobacterium abscessus （22.7%, 54/238） and Mycobacterium avium （10.1%, 24/238）, other species were only accounted for 14.7% （35/238）.The ranking of Mycobacterium avium went up rapidly from the fifth in 2014 to the second in 2016 （Х^2 =18.259, P 〈 0.01）, while proportion of Mycobacterium abscess, dropped from 34.9% （30/86） in 2014 to 17.5% （14/80） in 2016 （Х^2 =7.335, P〈0.01）.Among patients from whom the NTM strains were isolated, 56.7% （135/238） were male and most of them were aged 45 years or above （79.8%, 190/238）.Conclusions In the past three years, the trend of NTM isolation rate in Wenzhou is steady.The most prevalent NTM species is Mycobacterium intracellulare, followed by Mycobacterium abscessus and Mycobacterium avium.Mycobacterium avium shows a continuously upward trend, while the separation of Mycobacterium abscessus shows a downward trend.

关 键 词：分枝杆菌 非结核分枝杆菌 菌种鉴定 基因芯片 HSP65 HSP65 

分 类 号：R378.91[医药卫生—病原生物学]