广州地区鸟分枝杆菌和胞内分枝杆菌耐药性与临床预后的相关性

Correlation between drug resistance of Mycobacterium avium and Mycobacterium intracellulare and clinical prognosis in Guangzhou

目的明确广州地区鸟分枝杆菌复合群(MAC)不同菌种及药物敏感性与临床预后的关系。方法收集2018-2020年广州地区分枝杆菌菌株库保藏的MAC临床分离菌株,对临床资料齐全并确诊为MAC肺病患者的临床菌株进行16S rRNA、ITS、rpoB、hsp65多靶位基因测序将其鉴定至种,再应用微孔板法测定最低抑菌浓度确定其药物敏感性;根据患者临床症状、DR/CT影像学检查以及病原菌培养结果判断其临床治疗是否成功。结果(1)91株MAC临床分离菌株中胞内分枝杆菌63株(69.23%),鸟分枝杆菌21株(23.07%);(2)鸟分枝杆菌和胞内分枝杆菌对阿米卡星、乙胺丁醇的耐药率存在差异(P<0.05);(3)鸟分枝杆菌肺病和胞内分枝杆菌肺病的治疗成功率存在显著差异(66.67%vs.41.27%,χ^(2)=6.053,P<0.05)。结论广州地区MAC临床分离菌株以胞内分枝杆菌和鸟分枝杆菌为主,不同MAC菌种的耐药性及临床预后存在差异;对于NTM肺病患者,应对其进行菌种鉴定和体外药敏试验,并根据上述结果制定并优化临床治疗方案。

Objective To clarify the relationship between different species of Mycobacterium avium complex(MAC),drug sensitivity and clinical prognosis in Guangzhou.Methods The clinical isolates of MAC from 2018 to 2020 were collected from the Mycobacterium Strain Bank in Guangzhou,and the MAC strains of MAC lung disease patients were sequenced to identify them by 16S rRNA,ITS,rpoB,hsp65 multi-target gene sequencing.MIC50 and MIC90 of its minimum inhibitory concentration(MIC)were determined by microplate method to determine its drug sensitivity.The success of clinical treatment can be judged according to the clinical symptoms,DR/CT radiology and pathogen culture results.Results(1)There were 67 strains of Mycobacterium intracellulare(73.63%)and 21 strains of Mycobacterium avium(23.08%)in 91 clinical isolates of MAC.(2)The resistance rates of Mycobacterium avium and Mycobacterium intracellular to amikacin and ethambutol were different(P<0.05).(3)There was significant difference in the treatment success rate between M.aviumpulmonary disease and M.intracellularepulmonary disease(66.67%vs.41.27%,χ^(2)=6.053,P<0.05).Conclusion M.intracellulare and M.avium were the main clinical isolates of MAC in Guangzhou,and there were differences in drug resistance and clinical prognosis among different MAC species.For patients with NTM pulmonary disease,strain identification and in vitro drug susceptibility tests should be conducted,and clinical treatment protocols should be formulated and optimized based on the above results.