湖南省525株非结核分枝杆菌临床分离株的菌种鉴定与流行特征

Identification and epidemiological characteristics of 525 strains of nontuberculous mycobacteria isolated from a Hunan clinic

目的对2019-2020年湖南省分离的非结核分枝杆菌(NTM)进行菌种鉴定,并分析其分布特征,为非结核分枝杆菌病的防治提供基础科学依据。方法收集2019-2020年湖南省胸科医院疑似结核病患者分离到的分枝杆菌临床分离株,通过MPB64蛋白免疫胶体金法、PNB(对硝基苯甲酸)培养基生长试验进行结核分枝杆菌复合群和NTM鉴定,应用16S rRNA和Hsp 65测序分析法对NTM菌株进行菌种鉴定。结果共收集到6515份分枝杆菌阳性培养物,初步鉴定为NTM共525株,占比8.06%,其中分离于男性患者285株,占比54.29%;女性患者240株,占比45.71%;人群分布以农民为主,共367株,占比69.90%;年龄分布以40岁以上中老年患者最多,共402株,占比76.57%。2019-2020年NTM菌种分布达27种,菌种分布位列前4者分别为脓肿分枝杆菌(190株,36.19%)、胞内分枝杆菌(174株,33.14%)、鸟分枝杆菌(64株,12.19%)、戈登分枝杆菌(47株,8.95%);其它50株(9.52%)包含23种NTM。脓肿分枝杆菌主要在郴州市、湘西自治州地区、衡阳市和永州市等地区流行;胞内分枝杆菌主要在郴州市、岳阳市和湘潭市流行。结论2019-2020年湖南地区分枝杆菌中NTM检出率仍保持较高水平,以脓肿分枝杆菌、胞内分枝杆菌、鸟分枝杆菌和戈登分枝杆菌为主;感染人群以男性、中老年、农民为主。

Nontuberculous mycobacteria(NTM)isolated in Hunan from 2019 to 2020 were identified,and their distribution characteristics were analyzed to provide basic scientific evidence for the prevention and treatment of NTM diseases.Clinical isolates of mycobacteria from patients with suspected tuberculosis at the Hunan Chest Hospital from 2019 to 2020 were collected.The MPB64 protein immunogold method and p-nitrobenzoic acid growth tests were used to identify Mycobacterium tuberculosis complex and NTM.Subsequently,16S rRNA and Hsp 65 sequencing analyses were performed to identify the NTM strains.A total of 6515 positive cultures of mycobacteria were collected,and 525 strains were initially identified as NTM,accounting for 8.17%.Among them,285 isolates were from male patients,accounting for 54.29%,and 240 isolates were from female patients,accounting for 45.71%.The population distribu tion was dominated by farmers,with a total of 367 strains,accounting for 69.90%.Most patients were middle-aged(at least 40 years of age)or older,with 402 strains in total,accounting for 76.57%.Mycobacterium abscessum was mainly prevalent in Chenzhou,Xiangxi Autonomous Prefecture,Hengyang and Yongzhou;intracellular Mycobacterium was prevalent in Chenzhou,Yueyang and Xiangtan.In conclusion,from 2019 to 2020,we identified 27 species of NTM strains,of which the top four were Mycobacterium abscessus(190,36.19%),Mycobacterium intracellulare(174,33.14%),Mycobacterium avium bacillus(64,12.19%)and Mycobacterium gordonii(47,8.95%).The other 50 strains(9.52%)comprised 23 types of NTM.The detection rate of NTM among mycobacteria in Hunan from 2019 to 2020 remained high,and primarily comprised Mycobacterium abscesses,Mycobacterium intracellulare,Mycobacterium avium and Mycobacterium gordonii.The infected population mainly comprised men,people middle-aged or older,and farmers.