2012—2017年湖南省非结核分枝杆菌感染的特征分析

doi:10.3969/j.issn.1000-6621.2019.02.017

摘要/Abstract

摘要：

目的分析湖南省2012—2017年非结核分枝杆菌(NTM)的感染趋势、分布特征、流行状况,为湖南省NTM感染的防治提供参考依据。方法收集2012—2017年来自湖南省14个地级市、在湖南省胸科医院经BACTEC MGIT 960 法确诊为分枝杆菌感染的患者15576例,其中男性11126例,女性4450例。分离出分枝杆菌菌株15576株(每例患者1株)。采用MPB64蛋白免疫胶体金法、对硝基苯甲酸(PNB)生长试验进行结核分枝杆菌复合群(MTBC)与NTM的初步鉴别,应用16S rRNA、Hsp65测序法对初步鉴定为NTM的菌株进行菌种鉴定,并对NTM感染者的相关临床资料进行分析。结果 2012—2017年NTM检出率为10.17%(1584/15576);男性NTM感染者占62.06%(983/1584),女性占37.94%(601/1584);年龄分布中,40~岁的中老年患者最多,占39.02%(618/1584);职业分布以农民为主,占66.67%(1056/1584)。2016年NTM菌种分布达24种,位列前4者分别为:胞内分枝杆菌[25.23%(84/333)]、脓肿分枝杆菌[24.62%(82/333)]、戈登分枝杆菌[18.62%(62/333)]、鸟分枝杆菌[16.82%(56/333)];2017年NTM菌种分布达21种,位列前4者分别为:胞内分枝杆菌[27.15%(104/383)]、脓肿分枝杆菌[22.46%(86/383)]、戈登分枝杆菌[21.15%(81/383)],鸟分枝杆菌[17.49%(67/383)]。结论 2012—2017年湖南省NTM检出率处于较高水平,感染人群以男性、中老年、农民为主,以致病NTM菌居多。

关键词: 分枝杆菌感染, 分枝杆菌, 非典型性, 疾病特征, 序列分析

Abstract:

Objective To investigate the infection trend, distribution characteristics and prevalence of non-tuberculosis mycobacteria (NTM) infection in Hunan Province from 2012 to 2017, and provide reference for the prevention and treatment of NTM disease. Methods A total of 15576 patients were collected from 14 cities who were diagnosed as mycobacterial infections in the Hunan Chest Hospital by BACTEC MGIT 960 from 2012 to 2017, including 11126 males and 4450 females. 15576 strains of mycobacteria isolated (1 strain per patient). M.tuberculosis complex and NTM were identified by MPB64 colloidal gold and p-nitrobenzoic acid (PNB) growth test. NTM strains were for further strains identification by 16S rRNA and Hsp65 sequencing. Clinical datas of NTM infected patients were also collected and analyzed. Results The overall prevalence of NTM infection was 10.17% (1584/15576) between 2012 and 2017. The prevalence of NTM infection among the male patients was 62.06% (983/1584)which was higher than that among the female patients (37.94%,601/1584).The age distribution was dominated by the patients aged 40- years, accounting for 39.02% (618/1584). Occupation distribution was dominated by farmers, accounting for 66.67% (1056/1584). Twenty-four species were identified and the top four species were M.intracellular (25.23%,84/333), M.abscessus (24.62%,82/333), M.gordonae (18.62%,62/333) and M.avium (16.82%,56/333) in 2016. Twenty-one species were identified and the top four species were also M.intracellular (27.15%,104/383), M.abscesus (22.46%,86/383), M.gordonae (21.15%,81/383) and M.avium (17.49%,67/383) in 2017. Conclusion The prevalence of NTM infection in Hunan Province is high, and majorities of patients with NTM infection are mainly attributed to groups such as male patients, middle-aged and elderly and farmers, and the pathogenic NTM take the main proportion.

Key words: Mycobacterium infections, Mycobacteria,atypical, Disease attributes, Sequence analysis,DNA

陈忠南,易松林,胡培磊,郭靖玮,余艳艳,刘彬彬,易环,杨坤云,谭云洪. 2012—2017年湖南省非结核分枝杆菌感染的特征分析[J]. 中国防痨杂志, 2019, 41(2): 217-221. doi: 10.3969/j.issn.1000-6621.2019.02.017

Zhong-nan CHEN,Song-lin YI,Pei-lei HU,Jing-wei GUO,Yan-yan YU,Bin-bin LIU,Huan YI,Kun-yun YANG,Yun-hong TAN. Prevalence of nontuberculosis mycobacterium infection in Hunan Province between 2012 and 2017[J]. Chinese Journal of Antituberculosis, 2019, 41(2): 217-221. doi: 10.3969/j.issn.1000-6621.2019.02.017

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年份	分枝杆菌株数	非结核分枝杆菌
年份	分枝杆菌株数	株数	检出率(%)
2012	1783	52	2.92
2013	2231	170	7.62
2014	2389	265	11.09
2015	2722	378	13.89
2016	3013	336	11.15
2017	3438	383	11.14
合计	15576	1584	10.17

患者特征	2012年		2013年		2014年		2015年		2016年		2017年
患者特征	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)
性别
男	38	73.08	106	62.35	173	65.28	248	65.61	196	58.33	222	57.96
女	14	26.92	64	37.65	92	34.72	130	34.39	140	41.67	161	42.04
年龄组(岁)
<20	1	1.92	4	2.35	9	3.40	21	5.56	14	4.16	16	4.18
20~	13	25.00	37	21.77	52	19.62	86	22.75	73	21.73	105	27.41
40~	24	46.16	66	38.82	107	40.38	148	39.15	139	41.37	134	34.99
>60	14	26.92	63	37.06	97	36.60	123	32.54	110	32.74	128	33.42
职业
农民	22	42.31	136	80.00	212	80.00	247	65.35	197	58.63	242	63.19
企业职工	19	36.54	20	11.76	21	7.92	84	22.22	70	20.83	83	21.67
学生及其他	11	21.15	14	8.24	32	12.08	47	12.43	69	20.54	58	15.14