海南地区疑似肺结核患者非结核分枝杆菌感染特征

Characteristics of non-tuberculous Mycobacterial infection in suspected tuberculosis patients in Hainan area

摘要:

目的 了解海南地区疑似肺结核患者非结核分枝杆菌（NTM）的菌种分布、耐药性及临床感染特征。方法 收集2015年1月-2018年8月海南省某院疑似肺结核患者痰、肺泡灌洗液等呼吸道标本进行培养、菌种鉴定，对NTM感染情况、药敏结果，以及NTM肺部感染患者临床资料进行分析。结果 共有833份疑似肺结核患者阳性呼吸道标本，其中126份初步鉴定为NTM，经菌种鉴定，检出结核分枝杆菌3株，检出非分枝杆菌属细菌3株，检出的4株NTM无法鉴定至种，最终116份标本中检出NTM 118株。109例为单一NTM感染，7例为混合感染。有8种NTM菌种类型，主要以龟/脓肿分枝杆菌（41.5%）和胞内分枝杆菌（37.3%）为主。8种NTM菌种对8种一、二线抗结核药物呈不同程度的耐药，总耐药率最高的为异烟肼（96.6%），对8种抗结核药物全部耐药的比率高达32.2%。NTM肺部感染患者中男性少于女性，主要好发于中老年人，患者主要以海南沿海地区为主。NTM肺部感染患者主要临床表现为咳嗽咳痰、胸闷气促、血痰或咯血、食欲减退及体重下降，基础疾病既往有结核病史、支气管扩张、肺部感染及咯血，影像学表现为继发型肺结核、肺部空洞、胸膜肥厚、支气管扩张伴有肺气肿及肺部感染。结论 海南地区NTM肺部感染主要是以龟/脓肿分枝杆菌和胞内分枝杆菌为主，NTM对常用的抗结核药物均具有较高的耐药性，NTM肺部感染与肺结核应依据病原学检查进行鉴别。

Abstract:

Objective To understand the species distribution, antimicrobial resistance and clinical infection characteristics of non-tuberculous Mycobacteria (NTM) from suspected tuberculosis patients in Hainan area. Methods Sputum, alveolar lavage fluid and other respiratory tract specimens of suspected tuberculosis patients in a hospital of Hainan Province between January 2015 and August 2018 were collected, cultured and performed bacterial identification, NTM infection, antimicrobial susceptibility testing result and clinical data of patients with NTM pulmonary infection were analyzed. Results A total of 833 positive respiratory tract specimens were isolated from suspected tuberculosis patients, 126 of which were initially identified as NTM, identification of species showed that 3 strains were Mycobacterium tuberculosis, 3 were non-Mycobacterium, 4 were unable to be identified to species, among the other 116 pecimens, 118 strains of NTM were isolated. 109 cases were single NTM infection and 7 cases were mixed infection. There are 8 species of NTM, mainly Mycobacterium chelonae/Mycobacterium abscessus (41.5%) and Mycobacterium intracellular (37.3%). Eight NTM strains showed different degrees of resistance to 8 first-and second-line anti-tuberculosis drugs, the highest overall resistance rate was to isoniazid (96.6%), resistance rate to all 8 anti-tuberculosis drugs was as high as 32.2%. Incidence of NTM pulmonary infection in males was less than females, mainly in middle-aged and elderly people in Hainan coastal areas. The main clinical manifestations of patients with NTM pulmonary infection were cough and expectoration, chest tightness and shortness of breath, blood sputum or hemoptysis, loss of appetite and weight loss, underlying diseases included previous history of tuberculosis, bronchiectasis, pulmonary infection and hemoptysis, imaging manifestations showed secondary pulmonary tuberculosis, pulmonary cavity, pleural hypertrophy, bronchiectasis with emphysema and pulmonary infection. Conclusion NTM pulmonary infection in Hainan area is mainly caused by Mycobacterium chelonae/Mycobacterium abscessus and Mycobacterium intracellular, NTM is highly resistant to commonly used anti-tuberculosis drugs, NTM pulmonary infection and tuberculosis should be differentiated according to etiological examination.