安徽省非结核分枝杆菌临床分离率及人群分布和耐药性分析  

Analysis of the clinical isolation rate,population distribution and drug resistance of non-tuberculous mycobacteria in Anhui

作　　者：包训迪[1] 江跃 梁锁 程红燕 夏广秀 王超 叶倩 王舒 王庆[1] BAO Xun-di;JIANG Yue;LIANG Suo;CHENG Hong-yan;XIA Guang-xiu;WANG Chao;YE Qian;WANG Shu;WANG Qing(Laboratory of Anhui Chest Hospital(Anhui TB Institute),Hefei 230022,China)

机构地区：[1]安徽省胸科医院安徽省结核病防治研究所检验科,合肥230022

出　　处：《中国防痨杂志》2020年第7期718-724,共7页Chinese Journal of Antituberculosis

基　　金：2015年安徽省卫生计划委员会科研计划项目(15tb010)。

摘　　要：目的分析安徽省非结核分枝杆菌(NTM)临床分离率和人群分布及耐药性情况,为NTM的防治提供科学依据。方法按照分层整群抽样方法从全省86个结核病门诊抽取42个调查点,连续纳入2015年9月15日至2016年8月31日的涂阳疑似肺结核患者3047例,对痰标本酸性罗氏培养阳性的2652株菌株行菌种鉴定[对硝基苯甲酸(PNB)培养和早期分泌蛋白(MPB64)胶体金法]和基因测序(16S rRNA和hsp65 DNA测序),再对其中的NTM临床分离株在不同人群中的分布特征和耐药性检测(微孔板法)进行研究和分析。结果2652株培养阳性菌株经初步菌种鉴定获得122株NTM菌株,进一步经基因测序获得NTM临床分离株107株[符合率为87.70%(107/122),分离率为4.03%(107/2652)]、结核分枝杆菌12株、诺卡菌1株、污染菌2株;其中107株NTM共计分离出6种优势菌种,以胞内分枝杆菌[65.42%(70/107)]和脓肿分枝杆菌[25.23%(27/107)]为主。NTM菌株在复治[9.26%(41/443)]、女性[6.32%(39/617)]、≥40岁[5.11%(100/1956)]、退休[8.82%(12/136)]和农民[4.38%(86/1965)]、初中及以下学历([4.43%(97/2189)]、家庭年收入<2万元[4.98%(75/1506)]人群中的分离率均明显高于初治[2.99%(66/2209)]、男性[3.34%(68/2035)]、<40岁[1.01%(7/696)]、工人[0.96%(1/104)]、高中及以上[2.16%(10/463)]、家庭年收入≥2万元[2.83%(27/955)]者[χ^2值分别为37.434、10.854、36.387、17.021、18.995、8.748,P值分别为0.000、0.001、0.000、0.002、0.001、0.033]。104株(排除1株复苏失败的胞内分枝杆菌、1株草分枝杆菌和1株马赛分枝杆菌)菌株的药物敏感性试验结果显示,不同NTM对阿米卡星、利福布汀、克拉霉素和利福平的敏感度较高[分别为87.50%(91/104)、86.54%(90/104)、83.65%(87/104)、75.00%(78/104)],对亚胺培南/西司他丁、头孢西丁、米诺环素、多西环素等的耐药率较高[分别为100.00%(104/104)、95.19%(99/104)、94.23%(98/104)、93.27%(97/104)]。结论安徽省NTM的分离率较�Objective To analyze the clinical isolation rate,population distribution and drug resistance of non-tuberculous mycobacteria(NTM)in Anhui to provide a scientific basis for the prevention and treatment of NTM.Methods Using the stratified cluster sampling method,42 investigation points were collected from86 tuberculosis clinics in Anhui,and 3047 cases of smear-positive suspected pulmonary tuberculosis patients from September 15,2015 to August 31,2016 were continuously included.The 2652 positive strains with acid L-G medium were identified for strains(p-nitrobenzoic acid(PNB)culture and early secreted protein(MPB64)colloidal gold method)and gene sequencing(16 S rRNA and hsp65 DNA sequencing),and then the NTM was clinically isolated.The distribution characteristics and drug resistance detection(microplate method)of strains in different populations were studied and analyzed.Results The 2652 culture-positive strains obtained 122 NTM strains through preliminary strain identification;and by genetic sequencing,107 NTM clinical isolates(the coincidence rate was 87.70%(107/122),and the isolation rate was 4.03%(107/2652)),12 strains of Mycobacterium tuberculosis,1 strain of Nocardia,and 2 strains of contaminated bacteria were further obtained.Among them,a total of 6 dominant bacterial species were isolated from the 107 strains of NTM,mainly of Mycobacterium intracellulare(65.42%(70/107))and Mycobacterium abscessus(25.23%(27/107)).The rate of NTM isolation in retreatment(9.26%(41/443)),female(6.32%(39/617)),40 years old and above(5.11%(100/1956)),retirement(8.82%(12/136))and farmers(4.38%(86/1965)),junior high school and below(4.43%(97/2189))and family annual income<20000 CNY(4.98%(75/1506))were significantly higher than those in the initial treatment(2.99%(66/2209)),male(3.34%(68/2035)),under 40 years old(1.01%(7/696)),workers(0.96%(1/104)),high school and above(2.16%(10/463)),and family annual income≥20000 CNY(2.83%(27/955))(χ^2 values were 37.434,10.854,36.387,17.021,18.995 and 8.748,respectively;P values were 0.000,0.0

关 键 词：分枝杆菌 非典型性 细菌学技术 微生物敏感性试验 抗药性 细菌 流行病学研究 结果评价(卫生保健) 小地区分析 

分 类 号：R446.5[医药卫生—诊断学]