综合性医院非结核分枝杆菌临床分离株的菌种分布特征分析  

AnalYSiS of distribution characteristics of clinical isolates of nontuberculous mycobacteria in a general hospital

作　　者：沈瑶杰 刘伟 金嘉琳 蒋晓飞[3] 张雪莲[1] 张文宏 

机构地区：[1]复旦大学生命科学学院遗传工程国家重点实验室,上海200433 [2]复旦大学附属华山医院感染科 [3]复旦大学附属华山医院检验科 [4]杭州疾病预防控制中心结核病防治所

出　　处：《中华传染病杂志》2017年第10期580-584,共5页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金面上项目（81471987）

摘　　要：目的了解上海市当前流行的非结核分枝杆菌（NTM）病原谱，研究临床分离NTM的菌种分布特征，提高NTM的诊断水平，为指导和有效防治NTM感染提供参考。方法收集复旦大学附属华山医院2008年至2013年临床分离分枝杆菌阳性菌株，经热灭活处理抽提基因组DNA并采用16S rDNA、hsp65和rpoB 3个靶基因测序综合比对进行菌种鉴定。结果2008年1月至2013年12月，分枝杆菌分离培养的阳性率为4.1%（411/10 015），对剔除重复后的253株阳性菌株鉴定发现140株属于结核分枝杆菌复合群，102株NTM，以及11株奴卡菌，分别占55.3%、40.3%和4.4%。其中NTM的阳性率从2008年的25.0%持续增长至2013年的42.7%，2012年最高（54.9%）。进一步分析NTM菌种，菌种分布多达16种，其中数量最多的主要是脓肿分枝杆菌28株、海分枝杆菌18株、鸟-胞内分枝杆菌复合群17株，以及偶发分枝杆菌10株，分别占27.5%、17.6%、16.7%和9.8%。结论综合性医院临床分离NTM菌株数量及阳性率均呈上升趋势，NTM感染相关病例逐年增多，以脓肿分枝杆菌，以及海分枝杆菌、鸟-胞内分枝杆菌复合群和偶发分枝杆菌等为主。Objective To investigate the current prevalence of nontuberculous mycobacteria （NTM） in Shanghai, and to study the distribution characteristics of NTM clinical isolates, which may help to improve the diagnostic level of NTM and provide guidance for effective prevention and treatment of NTM infection.MethodsCulture-positive isolates of clinical mycobacteria were collected from 2008 to 2013 in Huashan Hospital affiliated to Fudan University. All isolates were heat inactivated, and the genomic DNA was extracted and the species were identified by comprehensive comparative analysis of 16S rDNA, hsp65 and rpoB target genes sequencing.ResultsFrom January 2008 to December 2013, the overall mycobacterial culture-positive rate was 4.1% （411/10 015）. After excluding the repeated isolates, a total of 253 culture-positive mycobacteria isolates were collected for the species identification. By genes sequencing analysis, 140 isolates were identified as mycobacterium tuberculosis complex （MTBc）, 102 NTM and 11 Nocardias, accounting for 55.3%, 40.3% and 4.4%, respectively. Positive rate of NTM isolates had an increasing trend from 25.0% in 2008 to 42.7% in 2013, reaching a highest rate of 54.9% in 2012. In further analysis of 102 NTM isolates, 16 species were identified. Among them, 28 were M. abscesses, 18 strains of M. marinum, 17 strains of M. avium-intracellulare complex and 10 strains of M. fortuitum, accounted for 27.5%, 17.6%, 16.7% and 9.8%, respectively.ConclusionsBoth of the isolation number and isolation rate of NTM in the general hospital are increasing. NTM related cases are also increasing in recent years, which mainly caused by M. abscess, M. marinum, M. avium-intracellulare complex and M. fortuitum.

关 键 词：非结核分枝杆菌 靶基因测序 菌种鉴定 菌型分布 

分 类 号：R446.5[医药卫生—诊断学]