2013-2018年徐州市非结核分枝杆菌感染分布和感染危险因素分析

Distribution and risk factors of non-tuberculosis Mycobacterium infection in Xuzhou City from 2013 to 2018

目的探究2013-2018年徐州市非结核分枝杆菌(non-tuberculous mycobacteria,NTM)感染分布和感染危险因素。方法选取2013年1月至2018年12月徐州地区各医疗机构所有疑似NTM病而转诊至徐州市传染病医院并被确诊的患者97例,作为感染组,分离出NTM菌株97株,对标本进行抗酸染色,PCR-反向点杂交,行分枝杆菌培养,并进行菌群菌种鉴定。分析NTM感染患者的性别、治疗史和户籍类型分布。选取同时期诊断为结核分支杆菌感染者136例,作为对照组。对NTM感染者进行单因素分析和非条件logistic回归分析。结果确诊NTM感染97例,分离出7种分枝杆菌,感染率分别为胞内分枝杆菌40.2%、鸟分枝杆菌24.7%、堪萨斯分枝杆菌12.4%、龟分枝杆菌10.3%、脓肿分枝杆菌8.2%、浅黄分枝杆菌3.1%和戈登分枝杆菌1.0%。男性鸟分枝杆菌感染率(17.5%比7.2%)和堪萨斯分枝杆菌感染率(10.3%比2.1%)均显著高于女性,差异均有统计学意义(P<0.05)。近一年化疗患者胞内分枝杆菌和鸟分枝杆菌感染率均显著高于有抗菌药物史和长期服用免疫抑制剂的患者,差异均有统计学意义(P<0.05)。各分枝杆菌在城镇和农村户籍之间差异无统计学意义(P>0.05)。单因素分析和非条件logistic回归分析结果显示,农村户籍(OR=4.67,95%CI:2.66~8.20)、支气管扩张(OR=5.59,95%CI:3.19~12.33)、薄壁空洞(OR=4.16,95%CI:2.10~8.22)、吸烟史10~20年(OR=3.38,95%CI:1.76~6.47)、吸烟史>20年(OR=3.23,95%CI:1.68~6.19)、结核菌素纯蛋白衍生物(purified protein derivative,PPD)试验弱阳性(OR=6.56,95%CI:3.59~11.99)、化疗史(OR=7.52,95%CI:2.46~23.02)、抗菌药物史(OR=2.96,95%CI:1.70~5.13)、长期服用免疫抑制剂(OR=5.11,95%CI:2.35~11.15)、饮用生水(OR=1.99,95%CI:1.09~3.61)和接触禽类史(OR=4.31,95%CI:2.47~7.51)是NTM感染的危险因素(P<0.05)。结论NTM感染者中,男性和化疗患者更易感染胞内分枝杆菌和鸟分枝杆菌,且农村户籍、薄壁空洞、吸烟史(>10年)、PPD弱阳性、化疗史、抗菌药物史、长期服用免疫抑制剂、饮用生水和接触禽类史是NTM感染的危险因素。

Objective To explore the non-tuberculous mycobacteria(NTM)infection distribution and risk factors of infection in Xuzhou City from 2013 to 2018.Methods Ninety-seven patients with suspected NTM disease found in various medical institutions in Xuzhou and referred to Xuzhou Infectious Disease Hospital from 2013 to 2018 were selected.Ninetyseven NTM strains were isolated,acid-fast staining,PCR-reverse dot hybridization,and branching were performed.The bacillus was cultured and the bacterial species were identified.The gender,treatment history,and household registration type distribution of NTM-infected patients were analyzed.Univariate analysis and unconditional logistic regression analysis were performed on NTM infected individuals.Results Ninety-seven cases were diagnosed as NTM infection.Seven mycobacteria were isolated.The names and infection rates were intracellular mycobacteria 40.2%,Mycobacterium avium 24.7%,Mycobacterium kansii 12.4%,and Mycobacterium turtles 10.3%,Mycobacterium abscessus 8.2%,Mycobacterium sphaeroides 3.1%,and Mycobacterium gordonus 1.0%.Mycobacterium tuberculosis infection rate(17.5%vs.7.2%)and Kansas Mycobacterium infection rate(10.3%vs.2.1%)in males were significantly higher than that in females.In the past year,the infection rate of Mycobacterium intracellulare and Mycobacterium avium was significantly higher than that of antibiotics and long-term immunosuppressive patients(P<0.05).There was no significant difference between urban and rural household registration(P>0.05).Univariate analysis and unconditional logistic regression showed rural household registration(OR=4.67,95%CI:2.66-8.20),Bronchiectasis(OR=5.59,95%CI:3.19-12.33),intrapulmonary cavity(OR=4.16,95%CI:2.10-8.22),smoking history 10-20 years(OR=3.38,95%CI:1.76-6.47),smoking history>20 years(OR=3.23,95%CI:1.68-6.19),PPD weakly positive(OR=6.56,95%CI:3.59-11.99),chemotherapy History(OR=7.52,95%CI:2.46-23.02),history of antibiotics(OR=2.96,95%CI:1.70-5.13),long-term use of immunosuppressants(OR=5.11,95%CI:2.35-11.15),Drinking raw water(OR=1.99,95%CI:1.09-3.61)and exposure to avian history(OR=4.31,95%CI:2.47-7.51)were risk factors for NTM infection(P<0.05).Conclusions After analysis of NTM infection in Xuzhou City from 2013 to 2018,it is found that male and chemotherapy patients are more susceptible to intracellular Mycobacterium and Mycobacterium avium,and rural household registration,lung cavity,smoking history of 10-20 years,smoking History>10 years,weak PPD positive,history of chemotherapy,history of antibiotics,long-term use of immunosuppressants,drinking raw water and exposure to poultry may be risk factors for NTM infection.