疑似肺结核患者肺泡灌洗液非结核分枝杆菌菌种分布及抗结核药物耐药性

Distribution of species of non-tuberculous Mycobacteria in bronchoalveolar lavage fluid of patients with suspected pulmonary tuberculosis and resistance to anti-tuberculosis drugs

目的分析疑似肺结核患者肺泡灌洗液(BALF)非结核分枝杆菌(NTM)菌种分布及抗结核药物耐药性。方法选取2020年8月-2022年10月舟山医院收治的疑似肺结核患者140例为研究对象,其中58例诊断为NTM肺病(NTM肺病组),82例诊断为肺结核(肺结核组),总结NTM肺病临床特征、菌种分布及耐药性。结果NTM肺病组既往患支气管扩张比例高于肺结核组(P<0.05);NTM肺病组血中性粒细胞占比低于肺结核组,白蛋白水平、支气管扩张影比例高于肺结核组(P<0.05);NTM肺病组BALF样本中共分离缓慢生长群39株(67.24%),其中胞内分枝杆菌最多(22株),快速生长群19株(32.76%),其中龟/脓肿分枝杆菌最多(18株);NTM肺病主要致病菌胞内分枝杆菌对氯法齐明耐药率为4.54%,对异烟肼、利福平、链霉素、乙胺丁醇、左氧氟沙星、阿米卡星、卷曲霉素、对氨基水杨酸、卡那霉素及利奈唑胺耐药率均高于70.00%;龟/脓肿分枝杆菌对异烟肼、利福平、链霉素、对氨基水杨酸耐药率为100.00%,对剩余8种抗菌药物的耐药率均高于80.00%。结论NTM肺病缺乏特异性临床特征,致病菌以胞内分枝杆菌、龟/脓肿分枝杆菌为主,对常规抗结核药物耐药性较高。

OBJECTIVE To investigate the distribution of non-tuberculous Mycobacteria(NTM)in bronchoalveolar lavage fluid(BALF)of patients with suspected pulmonary tuberculosis and analyze the resistance to anti-tuberculosis drugs.METHODS A total of 14O patients with suspected pulmonary tuberculosis who were treated in Zhoushan Hospital from Aug 2020 to Oct 2022 were recruited as the research subjects,58 of whom were diagnosed with NTM pulmonary disease(the NTM pulmonary disease group),and 82 were diagnosed with pulmonary tuberculosis(the pulmonary tuberculosis group).The clinical characteristics of NTM pulmonary disease,distribution of the species and drug resistance were summarized.RESULTS The proportion of patients with previous bronchiectasis was higher in the NTM pulmonary disease group than in the pulmonary tuberculosis group(P<o.05);the percentage of neutrophils of the NTM pulmonary disease group was lower than that of the pulmonary tuberculosis group,while the albumin level and the proportion of patients with bronchiectasis shadow were higher in the NTM pulmonary disease group than in the pulmonary tuberculosis group(P<0.05).Totally 39(67.24%)strains of slow-growth pathogens were isolated from BALF specimens of the NTM pulmonary disease group,22 of which were Mycobacterium intracellulare;19(32.76%)strains of fast-growth pathogens were isolated,18 of which were Mycobacterium chelonae/abscessus.As the major species of pathogens leading to NTM pulmonary disease,the drug resistance rate of M.intracellulare to clofazimine,and the drug resistance rates to isoniazid,rifampicin,streptomycin,ethambutol,levofloxacin,amikacin,capreomycin,aminosalicylic acid,kanamycin and linezolid were more than 70.00%;the drug resistance rates of the M.chelonae/abscessus to isoniazid,rifampicin,streptomycin and aminosalicylic acid were 100.00%,and the drug resistance rates to the rest of 8 types of antibiotics were more than 80.00%.CONCLUSION There are no specific clinical characteristics about the NTM pulmonary disease.M.intracellulare and M.chelonae/abscessus are the predominant species of pathogens and are highly resistant to the commonly used anti-tuberculosis drugs.