2013-2017年深圳市非结核分枝杆菌流行状况分析  

Analysis of epidemic characteristics of non-tuberculous mycobacteriuin strains in Shenzhen behveen 2013 - 2017

作　　者：洪创跃[1] 李金莉[1] 赵广录[1] 桂静[1] 朱玉梅[1] 杨争 余卫业 HONG Chuang-yue;LI Jin-li;ZHAO Guang-lu;GUI Jing;ZHU Yu-mei;YANG Zheng;YU Wei-ye(Shenzhen Center for Chronic Disease Cotitrol, Shenzhen 518020 , China)

机构地区：[1]深圳市慢性病防治中心,518020

出　　处：《中国防痨杂志》2019年第5期529-533,共5页Chinese Journal of Antituberculosis

基　　金：深圳市卫生计生系统重点学科建设能力提升项目(201606044).

摘　　要：目的分析深圳市非结核分枝杆菌(NTM)的流行状况.为NTM病防控策略提供依据。方法搜集2013 2017年深圳市慢性病防治中心和各区慢性病防治院收治的37 630例疑似肺结核患者.对上述患者进行痰分枝杆菌培养(BACTEC MGIT 960和改良罗氏法)检出阳性菌株8850株.采用MPB64免疫胶体金法和对硝基苯甲酸生长试验进行结核分枝杆菌复合群和NTM的初步菌种鉴定,对初步菌种鉴定为NTM的菌株应用HAIN基因分型鉴定法进行NTM菌种鉴定。分析NTM菌株在不同年度、性别、年龄、感染类型、地区来源、户籍来源,以及NTM不同种类菌株的分布特征。率的比较采用x^2检验.以P<0. 05为差异有统计学意义。结果8850株分枝杆菌培养阳性菌株中.初步菌种鉴定获得366株NTM菌株.检出率为4. 14%(366/8850);HAIN基因分型鉴定法确定293株NTM菌株的菌种.鉴定率为80. 05%(293/366)。2013-2017年深圳市NTM的检出率呈轻微上升趋势[3.81%(71/1864)~4.50%(82/1821)],但各年度间差异无统计学意义(x^2趋势= l.159.P=0. 885). 366 例 NTM感染患者中,女性患者的检出率[4. 87%( 144/2957)]明显高于男性患者[3. 77%(222/5893)](x^2=6.038,P =0.014);感染的高峰年龄均为25~34岁,分别占2& 83%(64/222)和23. 61%(34/144),差异无统计学意义(x^2=1.213,P=0.271).初治患者、郊区患者、流动人口患者、郊区流动人口患者的NTM检岀率[分别为2.31%(187/8104).1.77%(105/5909),3.89%(324/8323)、1.61%(91/5663)]明显低于复治患者[23.99%(179/746)]、市中心患者[8.87%(261/2941)]、户籍人口患者[7.97%(42/527)]、城区流动人口患者[8.77%(235/2681 )(x^2 =810. 400.249.512,20.778,248.418.P值均=0. 000)0 293株NTM分离株中,构成比占前3位者依次为脓肿分枝杆菌[41.64%(122/293)]、鸟-胞内分枝杆菌[22. 18%(65/293)]、堪萨斯分枝杆菌口6. 04%(47/293)];另外,发现7例[2.39%(7/293刀混合感染类型。结论深圳市近几年NTM检出率稳定,分布种类多样.以脓肿分枝杆菌、�Objective To explore epidemiologic characteristics of non-tuberculous mycobacterium (NTM) in Shenzhen to provide the basis for the control strategies of NTM. Methods Sputum were collected from 37 630 suspected tuberculosis patients selected from Shenzhen Center for (.'hronic Disease Control or each County Chronic Disease Control Hospital from 2013 to 2017. All the samples were cultured using BACTEC MGIT 960 and traditional culture, of them, 8850 strains were detected positive. MPB64 method and traditional PNB test were used to identify Mycobacterium tuberculosis complex and NTM preliminary. The initial NTM was further identified by the HAIN genotyping method. The year of onset, sex, age. infection types, regions, household registration source and the distribution characteristics of Nl'M strains were analyzd using C'hi-squeare test, PV0. 05 was considered statistically significant. Results With prevalence of 4.14%( 366/8850 ). 366 initial NTM strains were identified by 8850 mycobacterial strains. Two hundred and ninety-three NTM were further identified with the identification rate of 80. 05.(293/366) by HAIN genotyping method. The prevalence of NTM showed a slight upward trend from 2013 to 2017 in Shenzhen (3. 81 %(71 1864)-4. 50%(82, 1821)). but there was no statistically significant difference (X^2=1. 159, P=0. 885). In 366 NTM patients, the prevalence for female (4.87%(144/2957)) was more higher than male(3. 77%(222/5893))(X^2=6. 038,P=0. 014). The infection peak age of NTM patients was 25 - 34-yearold for both male and female (28. 83%(64/222) and 23.61%(34 144)), but no statistically significant was found (X^2= 1. 213,P=0. 271). The NTM rates in new patients? suburban patients? floating patients and suburban floating patients (2. 31%(187/8104), 1. 77%(105/5909), 3.89%(324/8323)and 1.61%(91/5663), respectively) were significantly lower than those of retreatment patients ( 23. 99%( 179/746 )), downtown patients ( 8. 87%(261/2941 )), register patients ( 7. 97 %(42/527)) and downtown floating patients (1.77%( 235/

关 键 词：分枝杆菌.非典型性 疾病特征 流行病学研究 小地区分析 

分 类 号：R52[医药卫生—内科学] R181.3[医药卫生—临床医学]