2009和2019年北京市非结核分枝杆菌流行特征比较

Comparison of the epidemiological characteristics of nontuberculous mycobacteria in Beijing,2009 and 2019

目的 分析北京市非结核分枝杆菌(nontuberculous mycobacteria,NTM)分离率及菌种分布情况,为科学制订北京地区分枝杆菌病的预防和控制策略提供理论依据。方法 采用回顾性调查方法,采用微阵列基因芯片法对本实验室2009和2019年度经对硝基苯甲酸(PNB)鉴别培养基鉴定为非结核分枝杆菌的菌株进行菌种鉴定,基因芯片检测技术与表型方法检测结果不同的菌株,经传代分离纯化后提取核酸对16SrRNA基因测序进行最终鉴定,两个年度非结核分枝杆菌分离率、菌种分布及流行病学情况均采用SPSS 17.0统计软件进行统计分析。结果 2009年分枝杆菌培养阳性菌株1 552株,鉴定出非结核分枝杆菌45株,分离率为2.90%,共分离出9个分枝杆菌菌种,2019年分枝杆菌培养阳性菌株1 254株,鉴定出非结核分枝杆菌81株,分离率为6.46%,共分离出9个分枝杆菌菌种;2009年缓慢生长型占86.67%,快速生长型占13.33%,2019年缓慢生长型占59.26%,快速生长型占40.74%,2009和2019年两年NTM分离率(χ^(2)=21.065,P﹤0.001)、菌种分布(χ^(2)=19.602,P=0.014)比较,差异均有统计学意义。2009年感染者中年龄在40岁以上人群占77.78%,2019年感染者中,年龄在40岁以上人群占67.90%;两个年份的年龄分布比较,差异具有统计学意义(χ^(2)=10.527,P=0.015),NTM分离率在0~19岁、20~39岁及60岁以上年龄段差异无统计学意义,在40~59岁年龄段差异有统计学意义(χ^(2)=9.800,P=0.002)。结论 北京地区非结核分枝杆菌分离率呈显著增高趋势,菌种分布从缓慢生长型占绝对优势向快速生长型、缓慢生长型趋于平均化转变,北京市40岁以上患者为高危人群,应积极开展分枝杆菌菌群、菌种鉴定。

Objective To analyze the isolation rate and strain distribution of nontuberculous mycobacteria in Beijing,to provide a theoretical basis for scientifically formulating prevention and control strategies for mycobacteria in Beijing.Methods A retrospective survey was conducted,the DNA microarray gene chip technology was used to identify the strains identified as nontuberculous mycobacteria by PNB identification medium in our laboratory in 2009 and 2019.The strains with different detection result of gene chip detection technology and phenotypic method were passed through generations of isolation and purification,the nucleic acid was extracted and the 16 SrRNA gene was sequenced for final identification.SPSS 17.0 statistical software was used for statistical analysis.Results In 2009,1 552 strains of mycobacteria were cultured and 45 strains of nontuberculous mycobacteria were identified,with an isolation rate of 2.90%.A total of 9 mycobacterial strains were isolated.In 2019,1 254 strains of mycobacterium culture-positive were identified and 81 nontuberculous mycobacterium strains were identified,with an isolation rate of 6.46% and a total of 9 mycobacterial species isolated.SGM accounted for 86.67%,RGM accounted for 13.33% in 2009,and SGM accounted for 59.26%,the RGM accounted for 40.74% in 2019.The difference in NTM separation rate(χ^(2)=21.065,P<0.001) and strain distribution(χ^(2)=19.602,P=0.014) between 2009 and 2019 were statistically significant;77.78% of those infected in 2009 were aged over 40 years and 67.90% of those infected in 2019 were aged over 40 years;Statistical analysis of the epidemiological data for the two years showed that the age distribution was statistically significant(χ^(2 )= 10.527,P = 0.015);the differences in NTM separation rate were not statistically significant in the age groups of 0-19,20-39 and ≥60 and the difference was statistically significant in the 40-49 age group(χ^(2)=9.800,P=0.002).Conclusions The isolation of nontuberculous mycobacteria in Beijing is increasing significantly.The distribution of strains is changing from SGM with absolute predominance to SGM and RGM tending to be even.Patients over 40 years of age in Beijing are a high-risk group.The identification of mycobacterial flora and bacterial species should be actively carried out.