长沙地区2012-2017年非结核分枝杆菌流行状况分析

Analysis on epidemic situation of Nontuberculous mycobacteriumin Changsha,Hunan area from 2012 to 2017

目的研究长沙地区近年来非结核分枝杆菌(NTM)的流行状况。方法采用对硝基苯甲酸(PNB)鉴别培养基和DNA微阵列芯片鉴定2012年1月至2017年7月该院分枝杆菌培养阳性菌株,并用绝对浓度法检测其耐药性。结果共分离10 779株分枝杆菌,其中NTM分离株867株,检出率8.04%。NTM检出率从2012年的6.2%上升到2017年的11.3%,呈逐年升高的趋势;867株NTM耐药率顺位依次为异烟肼(INH,99.88%)、对氨基水杨酸钠(PAS,99.77%)、吡嗪酰胺(PZA,99.42%)、乙硫异烟胺(TH,93.08%)、链霉素(SM,92.73%)、氧氟沙星(OFLX,83.85%)、利福平(RFP,76.27%)、乙胺丁醇(EMB,70.70%)、卡那霉素(KM,55.02%)。NTM对RFP、EMB和KM 3种药物的耐药率随年份有缓慢下降趋势;NTM种群分布达11种,占比居前3位的分别是胞内分枝杆菌(43.94%)、鸟分枝杆菌(24.11%)和龟或脓肿分枝杆菌(21.68%)。结论长沙地区分枝杆菌中NTM检出率持续升高,以胞内分枝杆菌、鸟分枝杆菌和龟或脓肿分枝杆菌为主;该地区NTM检出率低于全国第五次结核病流行病学调查结果,但仍属于较高疫情区域。

Objective To investigate the prevalence of Nor%tuberculous mycobacteria （NTM） in Changsha area in recent years. Methods The culture medium for identification of Mycobacteria and the DNA microarray chip were used to identify the positive strains of Mycobacterium culture from January 2012 to July 2017,and the drug resistance was detected by absolute concentration method. Results A total of 10 779 Mycobacteria and 867 NTM isolates were isolated,with a detection rate of 8. 04%. The detection rate of NTM increased from 6.2% in 2012 to 11.3% in 2017,showed an increasing trend;867 strains of NTM resistant rate of cis po sition followed by INH （99.88%）,PAS （99. 77%）,PZA （99. 42%）,TH （93. 08%）,SM （92.73%）,OFLX （83.85%）,RFP （76.27%） ,EMB （70.70%） and KM （55.02%）. There was a slow decline in drug resistance of NTM resistance to RFP,EMB and KM drugs year by year. NTM population distribution of 11 species,ac counting for the top three were Intracellular mycobacterium （43. 94%） of Mycobacterium avium （24. 11 %） and Mycobacterium abscessus （21.68%）. Conclusion The detection rate of NTM in Changsha area continues to rise,in which intracellular mycobacteria ,Mycobacterium avium and Mycobacterium abscessus take the main portion. The detection rate of NTM is lower than that of the fifth national tuberculosis epidemiological sur vey,but which still belongs to the higher epidemic area.