91株抗酸染色涂片阴性脓肿分枝杆菌复合群临床分离株亚种分布及耐药谱差异分析

doi:10.19982/j.issn.1000-6621.20260022

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (10): 1579-1589.doi: 10.19982/j.issn.1000-6621.20260022

91株抗酸染色涂片阴性脓肿分枝杆菌复合群临床分离株亚种分布及耐药谱差异分析

温淑芳¹^,², 任卫聪², 尚媛媛², 苏碧仪³, 李浩然², 逄宇²(), 刘毅¹()

¹ 北京市结核病胸部肿瘤研究所/首都医科大学附属北京胸科医院生物样本与数据资源库, 北京 101149
² 北京市结核病胸部肿瘤研究所/首都医科大学附属北京胸科医院细菌免疫学实验室/结核病防治关键技术北京市重点实验室, 北京 101149
³ 广州医科大学呼吸疾病国家重点实验室/结核病研究所, 广东药科大学附属广州市胸科医院临床检验科, 广州 510095

收稿日期:2026-01-13 出版日期:2026-10-10 发布日期:2026-09-30
通信作者: 逄宇,Email:pangyupound@163.com;刘毅,Email:18910250336@163.com
基金资助:
广州市科技市校(院)企联合资助项目(2023A03J0991);北京市属医学科研院所公益发展改革试点项目[京医研2023-15(JYY2023-15)

Differential analysis of subspecies distribution and antimicrobial resistance profiles of 91 acid-fast bacilli smear-negative clinical Mycobacterium abscessus complex isolates

Wen Shufang¹^,², Ren Weicong², Shang Yuanyuan², Su Biyi³, Li Haoran², Pang Yu²(), Liu Yi¹()

¹ Department of Biobank, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
² Beijing Key Laboratory for Key Technologies in Tuberculosis Prevention and Control, Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
³ State Key Laboratory of Respiratory Disease, Institute of Tuberculosis, Guangzhou Medical University, Department of Clinical Laboratory, Guangzhou Chest Hospital Affiliated to Guangdong Pharmaceutical University, Guangzhou 510095, China

Received:2026-01-13 Online:2026-10-10 Published:2026-09-30
Contact: Pang Yu,Email:pangyupound@163.com;Liu Yi,Email:18910250336@163.com
Supported by:
Science and Technology Program of Guangzhou(2023A03J0991);Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes(JYY2023-15)

摘要/Abstract

摘要：

目的: 分析中国多地区抗酸染色涂片阴性脓肿分枝杆菌复合群(Mycobacterium abscessus complex,MABC)临床分离株的亚种分布特征及耐药谱差异,探讨其临床指导意义。方法: 采用回顾性研究方法,纳入2020年1月1日至5月31日,来自中国8个省(自治区、直辖市)结核病定点医院收治的非结核分枝杆菌(non-tuberculous mycobacteria, NTM)肺病(初步鉴定为MABC感染)的患者103例。采用全基因组测序(whole genome sequencing,WGS)对分离株进行亚种精准鉴定,并采用微量肉汤稀释法测定15种抗菌药物的最低抑菌浓度(minimum inhibitory concentration,MIC)。结果: 在初步鉴定为MABC感染的103例患者临床分离株中,经WGS确证为MABC者91株。其中64株(70.33%)鉴定为脓肿分枝杆菌(Mycobacterium abscessus,M.ab),27株(29.67%)鉴定为马赛分枝杆菌(Mycobacterium massiliense,M.mas)。两亚种在3个年龄组(<45岁、45~59岁、≥60岁)中的整体分布差异有统计学意义(χ²=10.144,P=0.006)。进一步对各年龄组内两亚种的构成比进行两两比较发现,在中年组(45~59岁) M.ab构成比为10.94%(7/64),明显低于 M.mas(37.04%,10/27)(χ²=8.515,P=0.004);老年组(≥60岁) M.ab构成比为37.50%(24/64),明显高于 M.mas(14.81%,4/27)(χ²=4.587,P=0.032)。M.ab感染患者的咯血发生率为26.56%(17/64),明显高于M.mas(7.41%,2/27),差异有统计学意义(χ²=4.221,P=0.040);M.mas感染者的咳嗽症状发生率为96.30%(26/27),明显高于M.ab感染者(70.31%,45/64),差异有统计学意义(χ²=7.373,P=0.007)。M.ab对克拉霉素的耐药率为28.12%(18/64),明显高于M.mas(7.41%,2/27),差异有统计学意义(χ²=4.673,P=0.031)。结论: MABC 临床分离株中,M.ab为优势致病亚种,各亚种在年龄分布、临床症状、耐药表型及耐药风险上存在明显差异,临床诊断应提倡亚种水平的精准鉴定,进而针对不同亚种采用不同的治疗用药方案,以实现针对 MABC 感染的差异化精准治疗。

关键词: 分枝杆菌, 非结核性, 脓肿分枝杆菌, 全基因组测序, 微生物敏感性试验

Abstract:

Objective: To analyze the subspecies distribution characteristics and differences in drug resistance profiles of acid-fast bacilli (AFB) smear-negative clinical Mycobacterium abscessus complex (MABC) isolates from multiple regions in China, and to explore their clinical significances. Methods: A retrospective study was conducted on 103 patients with non-tuberculous mycobacteria (NTM) lung disease (preliminarily identified as MABC infection) admitted to tuberculosis-designated hospitals across eight provinces/autonomous regions/municipalities in China between January 1st and May 31st, 2020. Whole genome sequencing (WGS) was employed for precise subspecies identification of the isolates. The minimum inhibitory concentrations (MICs) of 15 antimicrobial agents were determined using the broth microdilution method. Results: Among the 103 isolates preliminarily identified as MABC, 91 were confirmed as MABC by WGS. Among them, 64 (70.33%) were identified as Mycobacterium abscessus (M.ab) and 27 (29.67%) as Mycobacterium massiliense (M.mas). Among the 91 MABC-infected patients, the distribution of the two subspecies across the three age groups (<45, 45-59, ≥60 years) showed a statistically significant difference (χ²=10.144, P=0.006). Further pairwise comparisons of the proportions of the two subspecies within each age group revealed that in the middle-aged group (45-59 years), the proportion of M.ab was 10.94% (7/64), significantly lower than that of M.mas (37.04%, 10/27; χ²=8.515, P=0.004). In the elderly group (≥60 years), the proportion of M.ab was 37.50% (24/64), significantly higher than that of M.mas (14.81%, 4/27; χ²=4.587, P=0.032). Regarding clinical symptoms, the incidence of hemoptysis in patients with M.ab infection was 26.56% (17/64), significantly higher than in those with M.mas (7.41%, 2/27; χ²=4.221, P=0.040), whereas the incidence of cough in patients with M.mas was 96.30% (26/27), significantly higher than in those with M.ab (70.31%, 45/64; χ²=7.373, P=0.007). Furthermore, the resistance rate of M.ab to clarithromycin was 28.12% (18/64), which was significantly higher than that of M.mas (7.41%, 2/27; χ²=4.673, P=0.031). Conclusion: M.ab is the dominant pathogenic subspecies among MABC clinical isolates. There are significant differences between subspecies in terms of age distribution, clinical symptoms, drug resistance phenotypes, and resistance risks. Accurate identification at the subspecies level should be advocated in clinical diagnosis to enable the adoption of tailored therapeutic regimens, thereby achieving differentiated precision treatment for MABC infections.

Key words: Mycobacterium, nontuberculous, Mycobacterium abscessus, Whole genome sequencing, Microbial sensitivity tests

中图分类号:

R378

温淑芳, 任卫聪, 尚媛媛, 苏碧仪, 李浩然, 逄宇, 刘毅. 91株抗酸染色涂片阴性脓肿分枝杆菌复合群临床分离株亚种分布及耐药谱差异分析[J]. 中国防痨杂志, 2026, 48(10): 1579-1589. doi: 10.19982/j.issn.1000-6621.20260022

Wen Shufang, Ren Weicong, Shang Yuanyuan, Su Biyi, Li Haoran, Pang Yu, Liu Yi. Differential analysis of subspecies distribution and antimicrobial resistance profiles of 91 acid-fast bacilli smear-negative clinical Mycobacterium abscessus complex isolates[J]. Chinese Journal of Antituberculosis, 2026, 48(10): 1579-1589. doi: 10.19982/j.issn.1000-6621.20260022

图/表 6

图1

表1

脓肿分枝杆菌复合群两亚种感染患者的人口学及临床特征比较 [例(构成比,%)]

临床特征	患者例数 (91例)	脓肿分枝杆菌 (64例)	马赛分枝杆菌 (27例)	χ²值	P值
年龄组(岁)				10.144	0.006
<45	46(50.55)	33(51.56)	13(48.15)
45~59	17(18.68)	7(10.94)	10(37.04)
≥60	28(30.77)	24(37.50)	4(14.81)
性别				0.573	0.449
女性	45(49.45)	30(46.88)	15(55.56)
男性	46(50.55)	34(53.12)	12(44.44)
治疗分类				0.890	0.345
初治	37(40.66)	24(37.50)	13(48.15)
复治	54(59.34)	40(62.50)	14(51.85)
标本类型				0.203	0.652
支气管肺泡灌洗液	16(17.58)	12(18.75)	4(14.81)
痰液	75(82.42)	52(81.25)	23(85.19)
临床表现
咳嗽				-^a	0.007
无	20(21.98)	19(29.69)	1(3.70)
有	71(78.02)	45(70.31)	26(96.30)
咯血				4.221	0.040
无	72(79.12)	47(73.44)	25(92.59)
有	19(20.88)	17(26.56)	2(7.41)
发热				-^a	0.543
无	77(84.62)	53(82.81)	24(88.89)
有	14(15.38)	11(17.19)	3(11.11)
胸痛				-^a	0.699
无	84(92.31)	58(90.62)	26(96.30)
有	7(7.69)	6(9.38)	1(3.70)
体质量下降				-^a	>0.999
无	84(92.31)	59(92.19)	25(92.59)
有	7(7.69)	5(7.81)	2(7.41)
其他症状				-^a	0.215
无	76(83.52)	51(79.69)	25(92.59)
有	15(16.48)	13(20.31)	2(7.41)
并发症
慢性阻塞性肺疾病				-^a	>0.999
无	85(93.41)	60(93.75)	25(92.59)
有	6(6.59)	4(6.25)	2(7.41)
支气管扩张症				0.193	0.660
无	61(67.03)	42(65.62)	19(70.37)
有	30(32.97)	22(34.38)	8(29.63)
哮喘				-^a	0.297
无	90(98.90)	64(100.00)	26(96.30)
有	1(1.10)	0(0.00)	1(3.70)
糖尿病				-^a	0.717
无	81(89.01)	56(87.50)	25(92.59)
有	10(10.99)	8(12.50)	2(7.41)
肝炎				-^a	0.357
无	85(93.41)	61(95.31)	24(88.89)
有	6(6.59)	3(4.69)	3(11.11)
HIV感染				-^a	0.297
无	90(98.90)	64(100.00)	26(96.30)
有	1(1.10)	0(0.00)	1(3.70)
恶性肿瘤				-^a	>0.999
无	86(94.51)	60(93.75)	26(96.30)
有	5(5.49)	4(6.25)	1(3.70)
自身免疫性疾病				-^a	>0.999
无	86(94.51)	60(93.75)	26(96.30)
有	5(5.49)	4(6.25)	1(3.70)
其他并发症				0.378	0.539
无	74(81.32)	51(79.69)	23(85.19)
有	17(18.68)	13(20.31)	4(14.81)

表1

表2

图2

图3

表3

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区域医疗单位	患者例数(91例)	脓肿分枝杆菌(64例)	马赛分枝杆菌(27例)
北方	43(47.25)	31(72.09)	12(27.91)
首都医科大学附属北京胸科医院	35(38.46)	26(74.29)	9(25.71)
西安市胸科医院	8(8.79)	5(62.50)	3(37.50)
南方	48(52.75)	33(68.75)	15(31.25)
广州市胸科医院	11(12.09)	10(90.91)	1(9.09)
湖南省胸科医院	8(8.79)	3(37.50)	5(62.50)
湖南省长沙市中心医院	6(6.59)	3(50.00)	3(50.00)
广西龙潭医院	8(8.79)	5(62.50)	3(37.50)
安徽省胸科医院	6(6.59)	5(83.33)	1(16.67)
厦门大学附属第一医院	5(5.49)	5(100.00)	0(0.00)
重庆市公共卫生医疗救治中心	4(4.40)	2(50.00)	2(50.00)
总计	91(100.00)	64(70.33)	27(29.67)

临床特征	患者例数 (91例)	联合耐药 (15例)	非联合耐药 (76例)	χ²值	P值
菌种亚型				4.538	0.034
脓肿分枝杆菌	64(70.33)	14(93.33)	50(65.79)
马赛分枝杆菌	27(29.67)	1(6.67)	26(34.21)
治疗分类				1.196	0.274
初治	37(40.66)	8(53.33)	29(38.16)
复治	54(59.34)	7(46.67)	47(61.84)
年龄组(岁)				3.156	0.206
<45	46(50.55)	5(33.33)	38(50.00)
45~59	17(18.68)	5(33.33)	21(27.63)
≥60	28(30.77)	5(33.33)	17(22.37)
性别				2.133	0.144
女性	45(49.45)	10(66.67)	35(46.05)
男性	46(50.55)	5(33.33)	41(53.95)
慢性阻塞性肺疾病				-^a	0.584
无	85(93.41)	15(100.00)	70(92.11)
有	6(6.59)	0(0.00)	6(7.89)
支气管扩张症				0.344	0.557
无	61(67.03)	9(60.00)	52(68.42)
有	30(32.97)	6(40.00)	24(31.58)

91株抗酸染色涂片阴性脓肿分枝杆菌复合群临床分离株亚种分布及耐药谱差异分析

Differential analysis of subspecies distribution and antimicrobial resistance profiles of 91 acid-fast bacilli smear-negative clinical Mycobacterium abscessus complex isolates

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