上海市某结核病定点医院非结核分枝杆菌肺病的诊断时间及影响因素分析  

Analysis of time for diagnosis of nontuberculous mycobacterial lung disease and its associated factors in a tuberculosis-designated hospital in Shanghai

作　　者：郑旭彬 何亦凡[1] 王丽[1] 孙勤[1] 申晓娜[1] 吴小翠[2] 杨景卉[2] 姚岚[1] 崔海燕[1] 徐飚[3] 余方友 沙巍[1] Zheng Xubin;He Yifan;Wang Li;Sun Qin;Shen Xiaona;Wu Xiaocui;Yang Jinghui;Yao Lan;Cui Haiyan;Xu Biao;Yu Fangyou;Sha Wei(Clinic and Research Centre of Tuberculosis,Shangnai Clinical Research Centre for Infectious Diease(Taberculosis)Shanghai Key Laboratory of Tuberculosis,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China;Department of Laboratory Medicine,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China;School of Public Health and Key Laboratory of Public Health Safety,Fudan University,Shanghai 200032,China)

机构地区：[1]同济大学附属上海市肺科医院结核病临床研究中心,上海市感染性疾病(结核病学)临床医学研究中心,上海市结核病(肺)重点实验室,上海200433 [2]同济大学附属上海市肺科医院检验科,上海200433 [3]复旦大学公共卫生学院,教育部公共卫生安全重点实验室,上海200032

出　　处：《中华结核和呼吸杂志》2023年第4期380-387,共8页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：上海市感染性疾病(结核病学)临床医学研究中心(19MC1910800);促进市级医院临床技能与临床创新能力三年行动计划(2020—2022年)结核病专病数据库建设(SHDC2020CR6024);上海市医学领军人才培养计划(2019LJ13)。

摘　　要：目的分析上海市某结核病定点医院2020—2021年非结核分枝杆菌(NTM)肺病患者的病原学特征、诊断所需时间及其影响因素,为进一步提高NTM肺病诊断效率,精准制定治疗方案提供依据。方法依托上海市肺科医院结核病专病数据库,获取2020年1月至2021年12月在本院结核科诊断的NTM病患者及其人口学、临床特征和细菌学数据开展回顾性研究。采用卡方检验、配对样本非参数检验以及logistic回归模型等方法,分析影响NTM肺病细菌学诊断时间的相关因素。结果研究共纳入294例细菌学诊断的NTM肺病患者,男147例,女147例,年龄中位数为61(46,69)岁。其中227例(77.2%)患者合并有支气管扩张。细菌学检测结果显示,鸟-胞内分枝杆菌复合群是NTM肺病的主要致病菌(56.1%),其次为堪萨斯(19.0%)和脓肿分枝杆菌(15.3%),而蟾蜍、玛尔摩等分枝杆菌合计占比仅3.1%。对标本类型分析发现,痰液、肺泡灌洗液和穿刺液标本培养阳性率分别为87.4%、80.3%、61.5%。按同一患者配对分析发现,痰液培养的阳性率明显高于涂片检查(87.1%比48.4%,P<0.01);而痰液和肺泡灌洗液标本NTM培养阳性率的差异无统计学意义(78.7%比77.3%,P>0.05)。有咳嗽或咳痰症状患者,痰液培养阳性的可能性分别提高了4.04(95%CI 1.80~9.05)和2.95(95%CI 1.34~6.52)倍;而女性或合并支气管扩张的患者,肺泡灌洗液培养阳性的可能性分别提高了2.82(95%CI 1.16~6.88)和2.38(95%CI 1.01~5.63)倍。NTM肺病诊断时间的中位数为32(26,42)d。多因素分析结果显示,有咳痰症状(aOR=0.48,95%CI:0.29~0.80)的患者,相较于无咳痰症状患者诊断所需时间更短。以鸟-胞内分枝杆菌肺病作为参照,脓肿分枝杆菌肺病诊断所需时间较短(aOR=0.43,95%CI 0.21~0.88),而少见NTM菌种诊断时间则相对较长(aOR=8.31,95%CI 1.01~68.6)。结论上海市某结核病定点医院诊断NTM肺病的主要致病菌为鸟-胞内分枝杆菌复合群,性别、�Objective To investigate the pathogenic characteristics,bacteriological diagnosis time and its associated factors among patients with nontuberculous mycobacterial(NTM)lung disease in a large tuberculosis-designated hospital in Shanghai from 2020 to 2021,in order to improve diagnosis efficiency and formulate precision treatment.Methods On the basis of the Tuberculosis Database in Shanghai Pulmonary Hospital,NTM patients diagnosed by the Department of Tuberculosis between January 2020 and December 2021 were screened.Demographic,clinical and bacterial information were retrospectively collected.Chi-square test,paired-sample nonparametric test and logistic regression model were used to analyze the factors associated with the diagnosis time of NTM lung disease.Results A total of 294 patients with bacteriologically confirmed NTM lung disease were included in this study,147 males and 147 females with a median age of 61(46,69)years.Of them,227(77.2%)patients had comorbidity of bronchiectasis.Species identification results showed that Mycobacterium Avium-Intracellulare Complex was the main pathogen of NTM lung disease(56.1%),followed by Mycobacterium kansasii(19.0%)and Mycobacterium abscessus(15.3%).Species such as Mycobacterium xenopi and Mycobacterium malmoense were rarely identified,accounting for a total proportion of only 3.1%.Positive culture rates for sputum,bronchoalveolar lavage fluid and puncture fluid were 87.4%,80.3%and 61.5%,respectively.Paired-sample analysis showed that the positive rate of sputum culture was significantly higher than that of smear microscopy(87.1%vs.48.4%,P<0.01),while no statistical difference was observed between sputum and bronchoalveolar lavage fluid on positive culture rate(78.7%vs.77.3%,P>0.05).Patients with cough or expectoration were observed with 4.04-fold(95%CI 1.80-9.05)or 2.95-fold(95%CI 1.34-6.52)higher probability of positive sputum culture,compared to those without.Regarding bronchoalveolar lavage fluid,female or patients with bronchiectasis had a 2.82-fold(95%CI 1.16-6.88)or

关 键 词：分枝杆菌感染 肺疾病 诊断 危险因素 上海市 

分 类 号：R521[医药卫生—内科学]