北京地区非结核分枝杆菌菌种分布及耐药性研究

Distribution and drug resistance of nontuberculous Mycobacteria in Beijing

目的 了解和分析北京地区非结核分枝杆菌（NTM）的菌种分布及耐药情况.方法 用PCR荧光探针法对北京结核病控制研究所菌株库中保存的2009年的1552株和2013年的1553株分枝杆菌菌株进行菌群鉴定,将所有鉴定为NTM的菌株用16S rRNA基因测序方法进行菌种鉴定,并用比例法对NTM菌株进行药敏试验.结果 采用SPSS 13.0统计学软件进行统计分析.结果北京地区2009年和2013年NTM分离率分别为3.8%（59/1552）和4.6%（71/1553）.分离出的130株NTM菌株用16 S rRNA基因测序进行鉴定,菌种为13种,其中胞内分枝杆菌占39.2%（51/130）,堪萨斯分枝杆菌占37.7%（49/130）,鸟分枝杆菌占6.9%（9/130）,脓肿分枝杆菌占5.4%（7/130）,偶然分枝杆菌占3.0%（4/130）,戈登分枝杆菌占1.5%（2/130）,蟾蜍分枝杆菌占1.5%（2/130）,瘰疬分枝杆菌、草分枝杆菌、耻垢分枝杆菌、母牛分枝杆菌、新金色分枝杆菌及熊本分枝杆菌各占0.8%（1/130）.130例NTM感染者中,男87例,女43例,平均年龄55岁,60岁及以上占40%（52/130）.比例法药敏试验结果显示,97株NTM对异烟肼和对氨基水杨酸耐药性最高,耐药率为98.0%（95/97）,其他依次为链霉素94.8%（92/97）,卷曲霉素81.4%（79/97）,阿米卡星69.1%（67/97）,左氧氟沙星56.7%（55/97）,利福平54.6%（53/97）,丙硫异烟胺51.5%（50/97）,乙胺丁醇50.5%（49/97）.结论 北京地区NTM分离菌种以胞内分枝杆菌和堪萨斯分枝杆菌为主,NTM分离者以男性居多,NTM对常用的抗结核药物均具有较高的耐药性.

Objective To analyze the distribution and drug resistance of nontuberculous mycobacteria（ NTM） in Beijing.Methods Using PCR-fluorescence probe method we identified 1552 mycobacterial isolates in 2009 and 1553 mycobacterial isolates in 2013, which were stored by Beijing Research Institute for Tuberculosis Control.All identified NTM strains were confirmed by 16S rRNA gene sequencing , and drug sensitivity testing was performed by using 1% ratio method.SPSS 13.0 was used for statistical analysis.Results The isolation rate for NTM in 2009 and 2013 was 3.8%（59/1552）,and 4.6%（71/1553） respectively.A total of 130 NTM strains were identified to 13 species by 16S rRNA gene sequencing , including M.intracellulare strains 39.2%（ 51/130 ） , M.kansasii strains 37.7%（ 49/130 ） , M.avium strains 6.9%（9/130）, M.abscessus strains 5.4%（7/130）, M.fortuitum strains 3.0%（4/130）, M.gordonae strains 1.5%（ 2/130 ）, M.xenopi strains 1.5%（ 2/130 ）, M.scrofulaceum, M.Phlei, M.smegmatis, M.vaccae, M.neoaurum, M.kumamotonense 1 strain each.For the patients infected with NTM, 87 were male and 43 were female, with an average age of 55 years.The results of drug sensitivity test from 97 strains of NTM showed that isoniazid and p-aminosalicylic acid showed the highest drug resistant rate of 98%（ 95/97 ） , followed by streptomycin 94.8%（ 92/97 ） , capreomycin 81.4%（ 79/97 ） , amikacin 69.1%（ 67/97 ） , levofloxacin 56.7%（ 55/97 ） , rifampicin 54.6%（ 53/97 ） , prothionamide 51.5%（50/97）, and ethambutol 50.5%（49/97）.Conclusions Mycobacterium intracellulare and Mycobacterium kansasii were the main strains isolated from patients infected with NTM in Beijing .Patients infected withNTM were mostly males.NTM showed high resistance to anti-tuberculosis drugs.