2021—2023年武汉地区非结核分枝杆菌肺病患者特征分析  

Characteristic analysis of non-tuberculous mycobacterial pulmonary disease patients in Wuhan area from 2021 to 2023

作　　者：王飞 华朵 郭建建 刘畅 韩璐 任易 Wang Fei;Hua Duo;Guo Jianjian;Liu Chang;Han Lu;Ren Yi(Department of Laboratory Medicine,Wuhan Pulmonary Hospital,Wuhan 430030,China;Department of Laboratory Medicine,Wuhan Blood Center,Wuhan 430030,China)

机构地区：[1]武汉市肺科医院检验科,武汉430030 [2]武汉市血液中心检验科,武汉430030

出　　处：《中国防痨杂志》2024年第9期1069-1076,共8页Chinese Journal of Antituberculosis

摘　　要：目的:对武汉地区呼吸道非结核分枝杆菌(NTM)的分离与耐药情况,以及确诊为NTM肺病患者的临床特征进行分析,为疾病的防治提供参考。方法:采用回顾性研究方法,搜集2021年3月至2023年10月于武汉市肺科医院就诊的疑似肺部分枝杆菌感染住院患者作为研究对象,共计8619例。研究对象年龄均≥15岁,呼吸道样本(包括痰、诱导痰、支气管肺泡灌洗液)分枝杆菌病原学(分枝杆菌培养)阳性和(或)菌种鉴定为NTM。收集所有研究对象的病史、临床特征、影像学表现、临床诊断及治疗等资料。对NTM菌株分离情况、人口学特征及耐药情况进行统计;将确诊为NTM肺病患者,按胞内分枝杆菌(胞内组)、脓肿分枝杆菌(脓肿组)及堪萨斯分枝杆菌感染(堪萨斯组)分为三组,比较各组研究对象的基本情况、临床症状、影像学表现、基础疾病及合并肺部疾病等方面的情况。结果:8619例研究对象中有629例的临床分离菌株鉴定为NTM菌株,NTM分离率为7.30%。共分离653株NTM菌株,主要菌种包括胞内分枝杆菌398株(60.95%)、脓肿分枝杆菌138株(21.13%)、鸟分枝杆菌41株(6.28%)、堪萨斯分枝杆菌41株(6.28%)。确诊为NTM肺病的510例患者中,女性297例(58.24%),主要临床症状为咳嗽(71.96%,367/510)、咳痰(51.76%,264/510)、咯血(26.67%,136/510);影像学表现主要为斑片影(61.57%,314/510)、结节影(65.49%,334/510)、支气管扩张影(79.02%,403/510)、空洞影(40.98%,209/510);基础疾病主要为贫血(24.12%,123/510)和低蛋白血症(24.90%,127/510);合并肺部疾病主要有肺气肿肺大疱(18.63%,95/510)、慢性阻塞性肺疾病(17.84%,91/510)。三组NTM肺病为胞内组332例、脓肿组115例、堪萨斯组35例。胞内组、脓肿组、堪萨斯组女性分别占55.12%(183/332)、75.65%(87/115)、17.14%(6/35),差异有统计学意义(χ^(2)=39.534,P<0.001);胞内组、脓肿组、堪萨斯组平均年龄分别为(63.60±10.67)岁、(60.60±10.26)岁、(Objective:This study aims to offer critical insights into the prevention and treatment of non-tuberculous mycobacterial pulmonary disease(NTM-PD)by analyzing the isolation rates and drug resistance patterns of respiratory non-tuberculous mycobacteria(NTM)in the Wuhan area,as well as the clinical characteristics of patients diagnosed with NTM-PD.Methods:This retrospective study encompassed 8619 hospitalized patients with suspected mycobacterial pulmonary infections at Wuhan Pulmonary Hospital from March 2021 to October 2023.All participants were aged 15 years or older,and their respiratory samples(including sputum,induced sputum,and bronchiolar lavage fluid)tested positive for mycobacterial etiology(via mycobacterium culture)and were identified as NTM.Comprehensive data on medical history,clinical features,radiological findings,clinical diagnosis,and treatment were collected for all subjects.The isolation rates,demographic characteristics,and drug resistance profiles of NTM strains were analyzed.Patients diagnosed with NTM-PD were categorized into three groups based on the infecting species:M.intracellular(M.intracellular group),M.abscessus(M.abscessus group),and M.kansasii(M.kansasii group).The baseline characteristics,clinical symptoms,radiological features,underlying diseases,and concomitant pulmonary conditions of each group were compared.Results:Among the 8619 subjects,629 clinical isolates were identified as NTM strains,resulting in an NTM isolation rate of 7.30%.A total of 653 NTM strains were isolated,comprising 398(60.95%)strains of M.intracellular,138(21.13%)strains of M.abscessus,41(6.28%)strains of M.avium,and 41(6.28%)strains of M.kansasii.Among the 510 patients diagnosed with NTM-PD,297(58.24%)were female.The primary clinical symptoms included cough(71.96%,367/510),expectoration(51.76%,264/510),and hemoptysis(26.67%,136/510).Key radiological features were patchy infiltrates(61.57%,314/510),nodules(65.49%,334/510),bronchiectasis(79.02%,403/510),and cavities(40.98%,209/510).The most common underlying c

关 键 词：非典型性细菌 分枝杆菌属 抗药性 细菌 疾病特征 

分 类 号：R563[医药卫生—呼吸系统] R378[医药卫生—内科学]