广州市非结核分枝杆菌病流行病学特征分析

doi:10.19982/j.issn.1000-6621.20240185

摘要/Abstract

摘要：

目的: 分析广州市非结核分枝杆菌(non-tuberculous mycobacteria,NTM)病的一般情况及流行病学特点,为制定和实施有效的预防和管理NTM病提供参考信息。方法: 回顾性分析2018年1月1日至2023年12月31日广州市新发NTM病患者2714例,并对各年度NTM病的检出率趋势,以及性别、年龄、菌种/群分布特点进行分析。使用9个连续的年龄段分析了年龄对NTM病的影响,并重点对比青年组(21~40岁)和中老年组(51~70岁)的检出差异;根据感染部位的不同,分成肺内组、肺外组、播散组三组进行分析。结果: 广州市6年新发NTM病的检出率呈波动趋势,由2018年的男性构成比41.10%(194例)下降至2023年的38.10%(205例),2018年的女性构成比由58.90%(278例)上升至2023年61.90%(333例),男性所占比例逐年降低,女性所占比例逐年升高。好发年龄段为51~70岁,占总病例的51.62%(1401/2714),青年组(21~40岁)构成比呈下降趋势,由2018年的23.09%(109/472)下降至2023年的16.36%(88/538);中老年组(51~70岁)构成比呈上升趋势,由2018年的48.31%(228/472)上升至2023年的55.76%(300/538)。6年广州市新发NTM病患者2714例,其中肺内组(97.09%,2635/2714)NTM分离菌种前4位分别是:鸟-胞内分枝杆菌复合群(M.avium complex,MAC)(43.42%,1144/2635)、龟-脓肿分枝杆菌复合群(Turtle-M.abscessus complex,MABC)(36.39%,959/2635)、堪萨斯分枝杆菌(8.50%,224/2635)、偶发分枝杆菌(4.10%,108/2635);肺外组(1.69%,46/2714)NTM分离菌种前4位分别是:MABC(34.78%,16/46)、偶发分枝杆菌(21.74%,10/46)、MAC(19.57%,9/46)、海分枝杆菌(15.22%,7/46);播散组(1.22%,33/2714)NTM分离菌种前4位分别是:MAC (42.42%,14/33)、MABC(27.27%,9/33)、堪萨斯分枝杆菌(15.15%,5/33)、偶发分枝杆菌(6.06%,2/33);MAC肺病构成比略上升,由2018年的39.19%(185/472)升至2022年的48.48%(176/363)和2023年的44.61%(240/538);MABC肺病构成比呈下降趋势,由2018年的38.98%(184/472)下降至2023年的30.30%(163/538)。结论: 广州市中老年患者对NTM易感,女性多于男性,青年组(21~40岁)构成比呈下降趋势,中老年组(51~70岁)构成比呈上升趋势;NTM肺病菌种以MAC、MABC为主,MABC肺病构成比呈下降趋势。

关键词: 分枝杆菌感染, 分枝杆菌,非典型性, 流行病学, 广州市

Abstract:

Objective: The general situation and epidemiological characteristics of non-tuberculous mycobacteria (NTM) disease in Guangzhou were analyzed to provide reference for development and implementation of effective prevention and management policy of NTM disease. Methods: To conduct a retrospective analysis of 2714 newly diagnosed cases of NTM disease in Guangzhou from January 1, 2018, to December 31, 2023. The study examined the annual detection rate trends of NTM disease, as well as the distribution characteristics by gender, age, and bacterial species/groups. We analyzed the impact of age on NTM disease across nine consecutive age groups, with a focus on comparing the detection differences between the youth group (21-40 years) and the middle-aged/elderly group (51-70 years). Additionally, based on the site of infection, we classified the cases into three groups: pulmonary, extrapulmonary, and disseminated, for further analysis. Results: The detection rate of new NTM disease in Guangzhou in 6 years was fluctuating. Male proportion decreased from 41.10% (194 cases) in 2018 to 38.10% (205 cases) in 2023, while female proportion increased from 58.90% (278 cases) to 61.90% (333 cases). The proportion of male decreased year by year, and the proportion of female increased year by year. The main age group was 51-70 years, accounting for 51.62% (1401/2714). The youth group (21-40 years) decreased from 23.09% (109/472) in 2018 to 16.36% (88/538) in 2023, and the middle-aged/elderly group (51-70 years) rose from 48.31% (228/472) to 55.76% (300/538). Among all 2714 patients with new NTM disease in Guangzhou in 6 years, the top 4 strains of NTM isolation from pulmonary group (97.09%, 2635/2714) were: bird-intracellular mycobacterium complex group (M.avium complex, MAC, 43.42%, 1144/2635), Turtle-Mycobacterium abscessus complex (Turtle-M.abscessus complex, MABC, 36.39%, 959/2635), Mycobacterium kansas (8.50%, 224/2635), and M.sp.contingent (4.10%,108/2635); the top 4 strains of NTM isolation from extrapulmonary group (1.69%, 46/2714) were: MABC (34.78%, 16/46), M.contingent (21.74%, 10/46), MAC(19.57%, 9/46), and Mycobacterium salina (15.22%, 7/46); the top 4 strains of NTM isolation from dissemination group (1.22%, 33/2714) were: MAC (42.42%, 14/33), MABC (27.27%, 9/33), Mycobacterium kansas ((15.15%, 5/33), and M.contingent (6.06%, 2/33). MAC induced lung disease composition ratio slightly increased, from 39.19% (185/472) in 2018 to 48.48% (176/363) in 2022 and 44.61% (240/538) in 2023, while MABC induced lung disease composition ratio decreased from 38.98% (184/472) in 2018 to 30.30% (163/538) in 2023. Conclusion: Middle-aged and elderly patients in Guangzhou are more susceptible to NTM, with a higher prevalence in females compared to males. The proportion of cases in the youth group (21-40 years) shows a declining trend, whereas the proportion in the middle-aged/elderly group (51-70 years) shows an increasing trend. The predominant species causing NTM pulmonary disease are MAC and MABC, with the proportion of MABC cases showing a downward trend.

Key words: Mycobacterial infection, Mycobacteria,atypical, Epidemiology, Guangzhou city

中图分类号:

R372
R563

梁锋, 刘德情, 陈华, 陈品儒, 谭耀驹, 胡锦兴, 张丹妮, 许柳清. 广州市非结核分枝杆菌病流行病学特征分析[J]. 中国防痨杂志, 2024, 46(11): 1373-1379. doi: 10.19982/j.issn.1000-6621.20240185

Liang Feng, Liu Deqing, Chen Hua, Chen Pinru, Tan Yaoju, Hu Jinxing, Zhang Danni, Xu Liuqing. Epidemiological characteristics of non-tuberculous mycobacterial disease in Guangzhou[J]. Chinese Journal of Antituberculosis, 2024, 46(11): 1373-1379. doi: 10.19982/j.issn.1000-6621.20240185

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年份	患者总例数	结核病例数	构成比(%)	NTM病例数	构成比(%)	结核病并发NTM病例数	构成比(%)
2018	2755	2280	82.76	472	17.13	3	0.11
2019	3390	2889	85.22	493	14.54	8	0.24
2020	2860	2445	85.49	408	14.27	7	0.24
2021	2901	2457	84.69	440	15.17	4	0.14
2022	2408	2042	84.80	363	15.07	3	0.13
2023	3115	2571	82.54	538	17.27	6	0.19
总计	17429	14684	84.25	2714	15.57	31	0.18

年份	男性(例)	构成比(%)	女性(例)	构成比(%)
2018	194	41.10	278	58.90
2019	199	40.37	294	59.63
2020	165	40.44	243	59.56
2021	178	40.45	262	59.55
2022	138	38.02	225	61.98
2023	205	38.10	333	61.90
总计	1079	39.76	1635	60.24

年份	0~10岁	11~20岁	21~30岁	31~40岁	41~50岁	51~60岁	61~70岁	71~80岁	81~93岁	总计
2018	1(0.21)	17(3.60)	55(11.65)	54(11.44)	70(14.83)	110(23.31)	118(25.00)	34(7.20)	13(2.76)	472(100.00)
2019	0(0.00)	10(2.03)	57(11.56)	51(11.44)	75(15.21)	114(23.12)	127(25.76)	49(9.95)	10(2.03)	493(100.00)
2020	1(0.24)	10(2.45)	38(9.32)	39(10.34)	50(12.25)	101(24.75)	108(26.47)	52(12.75)	9(2.21)	408(100.00)
2021	0(0.00)	9(2.05)	39(8.86)	40(9.56)	67(15.23)	110(25.00)	123(27.95)	42(9.54)	10(2.28)	440(100.00)
2022	0(0.00)	4(1.10)	29(7.99)	38(10.47)	49(13.50)	83(22.87)	107(29.48)	45(12.39)	8(2.20)	363(100.00)
2023	0(0.00)	13(2.42)	35(6.51)	53(9.85)	68(12.64)	147(27.32)	153(28.44)	63(11.71)	6(1.11)	538(100.00)
总计	2(0.07)	63(2.32)	253(9.32)	275(10.13)	379(13.96)	665(24.52)	736(27.12)	285(10.50)	56(2.06)	2714(100.00)

年份	MAC 例数	构成比 (%)	MABC 例数	构成比 (%)	堪萨斯例数	构成比 (%)	偶发例数	构成比 (%)	其他例数	构成比 (%)	NTM病总例数
2018	185	39.19	184	38.98	31	6.57	18	3.82	54	11.44	472
2019	198	40.16	196	39.76	33	6.69	23	4.67	43	8.72	493
2020	163	39.95	141	34.56	39	9.56	18	4.41	47	11.52	408
2021	182	41.36	161	36.59	34	7.73	16	3.64	47	10.68	440
2022	176	48.48	114	31.41	33	9.09	7	1.93	33	9.09	363
2023	240	44.61	163	30.3	54	10.04	26	4.83	55	10.22	538
总计	1144	42.15	959	35.34	224	8.25	108	3.98	279	10.28	2714