93例非结核分枝杆菌肺病患者临床分析

Clinical analysis of 93 patients with non-tuberculous mycobacteria pulmonary disease

目的总结非结核分枝杆菌(non-tuberculous mycobacteria,NTM)肺病临床特点、菌种分布及对常用抗结核药物的药敏情况。方法收集我院2009年12至2012年12月痰中分离的721株分枝杆菌,初步鉴定分出结核分枝杆菌和非结核分枝杆菌,并分析其中93株NTM对应的93例患者的临床特点、菌种分布以及对10种抗结核药物药敏结果。结果我院NTM肺病占全部痰分枝杆菌培养阳性患者的12.9%,该病临床多表现为咳嗽、咳痰90例(96.8%)、咯血40例(43.0%)、气喘30例(32.2%)等,影像学多表现为支气管扩张60例(64.5%)、空洞35例(37.6%)、斑片渗出30例(32.3%)等。NTM菌种包括:脓肿分枝杆菌41例(44.1%)、胞内分枝杆菌16例(17.2%)、堪萨斯分枝杆菌5例(5.4%)、鸟型分枝杆菌5例(5.4%)、戈登分枝杆菌3例(3.2%)、偶发分枝杆菌3例(3.2%),未做基因分型20例(21.5%)。药敏试验提示大多数NTM对10种抗结核药物耐药,尤其是脓肿分枝杆菌对10种抗结核药物全部耐药。结论NTM肺病发病率较高,临床医生应对NTM行菌种基因鉴定及药敏试验以指导治疗,目前对NTM病尚缺乏有效治疗药物,需要研究新型的抗NTM药物。

Objective To observe the incidence of the non-tuberculous mycobacteria（NTM） pulmonary disease and its clinical characteristics, the species distribution and the drug resistance to 10 antituberculosis agents, so that we can provide useful suggestion to the treatment of the disease. Methods First we classify 721 stains mycobacterium from December 2009 to December 2012 in our hospital into mycobacterium tuherculosis, mycobacterium bovis and NTM, and then we identify the species genotypes of the NTM with the method of PCR-RDBHA, subsequently we perform the susceptibility test to 10 antitubereulosis agents. Results The ratio of the NTM pulmonary is 12.9% in the total patient with positive mycobacterium sputum cuhute. The common clinical manifestations include cough and expectoration （90 patients 96.8% ）, hemoptysis （40 patients 34.0%）, dyspnea （30 patients 32.2%）, etc. Its imaging characteristics include bronchiectasis（60 patients,64.5）, confluent density（30 patients,32.3%）, nudular lesion（20 patients,21.5%）, etc. The species distribution of the NTM are as follows in order： Mycobacterium abscessus（4,1 patients,44.1%）, Mycobacterium intracellulare （16patients,17.2%）, Mycobacterium kansasii （5 patients,5.2%）, Mycobacterium avium （5 patients,5.2%）, Mycobacterium gordonae （3 patients,3.2%）, Mycobacterium fortuitum （3 patients,3.2%）, 20 patients （21.5%） had not perform the species genotypes identification. The susceptibility test show that NTM are different levels of resistance to most of 10 agents, especially M. abscessus showed resistance to all drugs. Conclusion NTM pulmonary disease is in higher prevalence in our hospital as well as other place, clinicians should pay more attention to the diagonosis and treatment of the disease, it is necessary to perform the species genotypes identification and the susceptibility test of NTM. As the NTM is in ascending prevalence and it is highly resistant to most agents, it is urgent to develop effective medicines.