非结核分枝杆菌在活动性肺结核患者中的病原监测结果分析

Pathogen detection results analysis of Nontuberculous Mycobacterial in patients with active tuberculosis

目的对活动性肺结核患者的病原菌进行监测，为临床诊断和治疗提供依据。方法对正定县疾控结核门诊2012年1月1日～2012年12月31日期间确诊的198例活动性肺结核患者采集痰标本（其中痰涂片阳性62例，痰涂片阴性136例），用传统方法进行培养、菌群鉴定和药物敏感试验（INH、RFP、EMB、SM、OFX、KM6种药物）。对确诊的非结核分枝杆菌（NTM）患者进行病史追查、治疗随访。结果涂片阳性患者培养阳性59例，涂阳培阳率95．16％，菌群鉴定结果：结核分枝杆菌56例、非结核分枝杆菌3例，非结核分枝杆菌占涂阳培阳的5．08％，占涂阳患者的4．84％。涂片阴性培养阳性36例，涂阴培阳率26．47％，菌群鉴定结果：结核分枝杆菌30例、非结核分枝杆菌6例，非结核分枝杆菌占涂阴培阳的16．67％，占全部涂片阴性的4．41％。9例非结核分枝杆菌患者的药敏结果：1例新涂阳患者对6种药物全敏感、1例复发涂阳患者对6种药物均耐药，其余患者对6种药物不同类型有不同的耐药情况。非结核分枝杆菌病病史：3例有明确的结核病史、3例症状持续数年但未明确诊断、3例为新发患者，1年以上病史者占66．67％。结论非结核分枝杆菌肺病被误诊为恬动性肺结核的现象不容忽视，尤其是病史较长的活动性肺结核患者；痰培养、菌群鉴定和药敏试验应成为指导临床诊断和治疗的依据。

Objective To detect the agnosis and treatment. Methods pathogen of the patients with active tuberculosis provide basis for clinical di-During 1st of January - 31st of December of 2012, in tuberculosis clinic of center for disease control and prevention in Zhengding county, 198 cases patients with active mycobacterial lung diseases confirmed by culture with traditional method （including 62 positive cases , 136 negative cases）, to cultivated, bacteria groups were identified and carried out drug susceptibility test （INH, RFP, EMB, SM, OFX, KM , 6 kinds of drugs）, to conduct track history and follow - up treatment diagnosis for patients with non - tuberculosis mycobacteria （NTM） . Results 59 cases of smear positive patients were cultivating posi-tive, positive rates are 95. 16%. Bacteria groups identification results： 56 strains were identified with tubercu-losis mycobacterium, 3 strains （5.08%） were identified as NTM, take 4. 84% among the positive patients. 36 cases of smear negative patients were cultivating positive, positive rates are 26. 47%. Bacteria groups iden-tification results： 30 strains were identified with tuberculosis mycobacterium, 6 strains （16. 67% ） were identi-fied as NTM. Take 4. 84 % among all the smears. 9 NTM strains were performed drug susceptibility test, in which I case new smear positive is sensitive with all 6 drugs, 1 case relapse smear positive is tolerance with all 6 drugs, others 6 cases tolerant with different drugs respectively. Medical history of non - tuberculous myco-bacterial diseases： 3 cases had a clear history of tuberculosis; 3 cases had symptoms persist for several years but not a definite diagnosis; 3 cases were new patients; in which 66. 7% had a medical history more than one year. Conclusions Nontuberculous mycobacterial lung diseases is misdiagnosed as active tuberculosis should not be ignored, especially the patients with longer history of active tuberculosis; sputum samples with active tuberculosis, drug susceptibility test and becteria group identification should become the guidance of clinical diagnosis and treatment.