40例堪萨斯分枝杆菌肺病的临床特征及药敏特点分析

Analysis of clinical characteristics and drug susceptibility of 40 cases of mycobacterium kansasii pulmonary disease

目的分析堪萨斯分枝杆菌肺病的临床特征及药敏特点。方法回顾分析2016年1月至2021年2月期间本院确诊的非结核分枝杆菌(NTM)肺病患者的临床资料;将NTM肺病分为堪萨斯分枝杆菌肺病组和非堪萨斯NTM肺病组,对两组的临床特征进行比较。结果164例NTM肺病的菌种分布为胞内分枝杆菌(64.0%)、堪萨斯分枝杆菌(24.4%)、其它少见NTM(11.6%)。堪萨斯分枝杆菌肺病高发年龄为20~49岁,男性多见,主要症状为咳嗽咳痰、咯血、胸痛、胸闷、发热。堪萨斯分枝杆菌肺病病灶多累及单叶、上叶;主要表现为空洞、结节、索条影、斑片及实变等;空洞以薄壁空洞为主。堪萨斯组IGRAs的阳性率为55.0%,明显高于非堪萨斯组的11.3%(P<0.01)。堪萨斯分枝杆菌对常用的抗分枝杆菌药物的耐药率分别为利福平5.0%、异烟肼82.5%、乙胺丁醇30.0%、阿米卡星42.5%、氧氟沙星22.5%。结论堪萨斯分枝杆菌为NTM肺病的常见分离菌株之一。堪萨斯分枝杆菌肺病多见于中青年男性;肺部病灶上叶多见,形态多样,空洞常见;利福平耐药率较低,异烟肼耐药率较高。

Objective To analyze the clinical features and drug susceptibility of Mycobacterium kansasii(MKA)pulmonary disease.Methods Retrospective analysis was performed on the clinical data of patients with non-tuberculous mycobacterium(NTM)pulmonary disease diagnosed in our hospital from January 2016 to February 2021.NTM pulmonary disease was divided into MKA pulmonary disease group and the non-kansasii NTM pulmonary disease group,and the clinical features of the two groups were compared.Results The bacterial species distribution of 164 cases of NTM lung disease was Mycobacterium intracellular(64.0%),MKA(24.4%),and other rare NTM strains(11.6%).The high incidence of MKA pulmonary disease was 20-49 years old with a male predominance,and the main clinical manifestations were cough and sputum,hemoptysis,chest pain,chest tightness,and fever.The major MKA pulmonary disease lesions involved single lobes and upper leaf and manifested as cavities,nodules,stripe shadows,patches,and consolidation.The majority of voids were thin-walled voids.The positive rate of IGRAs in kansasii group was 55.0%,which was significantly higher than the 11.3%in the non-kansasii group(P<0.01).The drug resistance rates of MKA to commonly used anti-mycobacterium drugs were rifampicin 5.0%,isoniazid 82.5%,Myambutol 30.0%,amikacin 42.5%,and ofloxacin 22.5%,respectively.Conclusion MKA is one of the common isolates of NTM pulmonary disease.MKA pulmonary disease is more common among young and middle-aged men.The lesions are mostly located in the upper lobe,with various shapes and common cavities.The drug resistance rate to rifampicin is lower,while the resistance rate to isoniazid is higher.