广州地区艾滋病患者合并感染分枝杆菌菌种的分布特征

The mycobacterial species distribution in acquired immunodeficiency syndrome patients in Guangzhou

目的探讨广州地区艾滋病患者合并感染分枝杆菌菌种的分布特征。方法选择艾滋病合并分枝杆菌感染患者133例，非艾滋病合并分枝杆菌感染患者150例。提取分枝杆菌基因组DNA，用多基因测序分析的方法鉴定菌株。比较艾滋病患者与非艾滋病患者感染分枝杆菌的菌种分布，分析艾滋病患者CD4^＋T淋巴细胞水平与分枝杆菌菌种分布特点。计数资料的比较采用x^2检验。结果在艾滋病患者感染的133株分枝杆菌中，结核分枝杆菌复合群82株，非结核分枝杆菌51株；非结核分枝杆菌以鸟分枝杆菌复合群为主有31株。非艾滋病患者感染150株分枝杆菌中，结核分枝杆菌复合群126株，非结核分枝杆菌24株；非结核分枝杆菌以脓肿分枝杆菌为主（9株）。艾滋病患者CD4^＋T淋巴细胞计数≤100／μL时，分枝杆菌的检出率为75．94％（101／133），鸟分枝杆菌复合群的检出率为93．55％（29／31），其他非结核分枝杆菌的检出率为85．OO％（17／20）；CD4^＋T淋巴细胞计数〉100／μL时，各菌种的检出率均明显下降。结论广州地区艾滋病患者感染非结核分枝杆菌显著高于非艾滋病患者，且分别以鸟分枝杆菌复合群为主和以脓肿分枝杆菌为主。艾滋病患者CD4^＋T淋巴细胞计数越低，分枝杆菌感染率越高。

Objective To investigate the characteristics of mycobacteria species distribution in human immunodeficiency virus （HIV）-positive patients co-infected with mycobacteria in Guangzhou. Methods A total of 133 mycobacteria strains isolated from HIV-positive patients and 150 strains isolated from HIV-negative patients were included in this study. After DNA extraction of mycobacteria, mycobacteria species identification was performed by sequencing of multiple genes. Differences in the identified species were compared between patients with and without HIV infection and the correlation between CD4^＋ T cells level and the mycobacterial species distribution was analyzed. Chiquare test was used for statistical analysis. Results Of the 133 mycobacteria strains isolated from HIV-positive patients, 82 were identified as Mycobacteriurn tuberculosis complex （MTC）. Fifty-one were identified as nontuberculous mycobacteria （NTM）, of which the main species was Mycobacterium avium complex （MAC, 31/51）. Of the 150 mycobacteria strains isolated from HIV-negative patients, 126 were identified as MTC and 24 as NTM, of which the main species was Mycobacteriurn abscessus （9/24）. In patients with CD4^＋ T cell counts ≤100/μL, the positive rate of mycobacteria was 75.94% （101/133）, 93.55% （29/31） of MAC and 85.00%（17/20） of other NTM. When the CD4^＋ T cell counts 〉100/μL, the positive rate for myeobaeteria were all obviously decreased. Conclusions The proportion of NTM infection is higher in HIV-positive patients than HIV-negative patients in Guangzhou. Among HIV-positive patients, the most prevalent NTM species is MAC, while Mycobacterium abscessus is the most common species in HIVnegative patients. Mycobacterial infection in acquired immunodeficiency syndrome patients is closely associated with low CD4^＋ cells level.