无锡地区非结核分枝杆菌肺病临床特征及耐药特点分析

Clinical features and analysis of drug resistance characteristics of nontuberculous mycobacterial lung disease in Wuxi

目的探讨无锡地区非结核分枝杆菌(NTM)肺病患者临床特征、耐药特点。方法回顾分析2010年-2012年本院经菌种鉴定为NTM肺病51例患者的临床资料,进行药物敏感性测定,对耐药状况进行分析,观察治疗效果。结果NTM肺病以老年男性多见,常见于支气管扩张患者,临床特点及影像学与肺结核相似,痰涂片找抗酸杆菌阳性率高,耐药率高,低浓度组耐药率由高到低依次为INH(100.00%)>PAS(98.04%)>SM(92.16%)>PZA(90.20%)>OFX(88.24%)>Am(86.27%)>RFP(84.31%)>Pa(82.35%)>Pto(80.39%)>Cm(72.55%)>EMB(70.59%);高浓度组耐药率由高到低者依次为PAS(94.12%)>PZA(88.24%)>INH(80.39%)>Pa(78.43%)>OFX(76.47%)>SM(74.51%)>RFP(72.55%)>Am(62.75%)>Cm(56.86%)>Pto(54.90%)>EMB(43.14%);多数耐8种药物以上,低浓度组中有45.10%全耐药,高浓度组中有35.29%全耐药,无全敏感者,治疗效果差。结论无锡地区NTM肺病耐药率高,治疗效果差,有支气管扩张且痰涂片抗酸菌检查阳性的患者,需提高警惕性,及时进行分枝杆菌的菌型鉴定,避免延误NTM肺病的诊断和治疗。

Objective To investigate the clinical features, and characteristics of drug resistance of nontuberculosis mycobacteri-um（NTM） patients in Wtrxi. Methods To retrospectively analyze the clinical data of 51 cases NTM identified by our hospital from 2010 to 2012 year for the susceptibility test, and the resistance situation was analyzed, and the therapeutic effect was ob- served. Results NTM lung diseases occurred mostly in aged men, often in patients with bronchiectasis, the clinical features and imaging characteristics were similar to pulmonary tuberculosis. The positive rate of acid fast bacilli in sputum smear was high with high resistance rate. And the drug resistance rate of low concentration group, from high to low in order, were INH （100.00%） 〉 PAS （98.04%） 〉 SM （92.16%） 〉 PZA（90.20% ） 〉 OFX（88.24% ） 〉 Am （86.27%） 〉 RFP （84.31%） 〉 Pa （82.35%） 〉 Pto （80.39%） 〉 Cm （72.55%） 〉 EMB（70.59% ） ; the drug resistance rate of high concentration group, from high to low in order, were PAS （94.12%） 〉 PZA （ 88.24% ） 〉 INH （ 80.39% ） 〉 Pa （78.43 % ） 〉 OFX （ 76.47% ） 〉 SM （ 74.51% ） 〉 RFP（72.55% ） 〉 Am（62.75% ） 〉 Cm（56.86% ） 〉 Pro（54.90% ） 〉 EMB（43.14% ）; the majority were resistant to more than eight drugs, 45.10% of the low concentration group were of total resistance, 35.29% of the high concentration group were of total resistance. There was no full sensitivity, and treatment effect was poor. Conclusion The drug resistance rate of NTM in Wuxi area is high and the treatment effect is poor. Patients with bronchiectasis and sputum smear acid fast bacilli positive should raise vigilance, and identify Mycobacterium in time, in order to avoid delays in the diagnosis and treatment of NTM disease.