2019-2021年陕西省结核病防治院患者的非结核分枝杆菌菌种分布特征及流行情况

Species distribution and spread of non-tuberculous Mycobacteria in patients of Shaanxi Provincial Tuberculosis Prevention and Control Hospital,2019−2021

目的分析陕西省结核病防治院患者的非结核分枝杆菌(NTM)菌种分布特征及流行情况,为临床诊断及防治提供依据。方法回顾性分析陕西省结核病防治院2019年7月至2021年12月分枝杆菌核酸检测阳性的呼吸道样本,对检出的NTM使用基因芯片法进行菌种鉴定统计不同菌种构成比,χ^(2)检验分析人口学资料及临床特征,采用logistic回归进行以肺部病灶严重程度为结局,评估不同NTM对肺部的病理损伤程度。结果NTM分离率为3.5%(128/3646);共检出7个菌种,前3位的分别是胞内分枝杆菌47份(36.7%,47/128)、龟/脓肿分枝杆菌34份(26.6%,34/128)、堪萨斯分枝杆菌32份(25.0%,32/128);年龄分布提示不同的NTM感染患者年龄构成比差异有统计学意义(χ^(2)=25.727,P<0.001),居住地差异有统计学意义(χ^(2)=15.227,P=0.002);多因素logistic回归分析显示,龟/脓肿分枝杆菌感染对肺部病理损伤程度较其他两种细菌轻(OR=0.188,P=0.039)。结论非结核分枝杆菌的种类主要以胞内分枝杆菌、龟/脓肿分枝杆菌、堪萨斯分枝杆菌这三类为主,且不同的NTM菌种对肺部的病理损伤程度不同。

Objective To understand the species distribution and spread of non-tuberculous Mycobacteria(NTM)in Shaanxi province and provide evidence for clinical diagnosis and prevention of the infections.Methods Retrospective analysis was conducted on the Mycobacterium nucleic acid positive respiratory tract samples collected in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from July 2019 to December 2021.The detected NTM strains were identified by gene chip method and the composition ratio of different species was analyzed.The demographic data and clinical characteristics of the cases were analyzed byχ^(2)test.Logistic regression analysis was used to evaluate the pathological damage degree of different NTMs in lungs based on the severity of lung lesions.Results The isolation rate of NTM was 3.5%(128/3646).A total of 7 species of NTM were detected,the first 3 were M.intracellular(36.7%,47/128),M.chelonis/abscess(26.6%,34/128),and M.Kansas(25.0%,32/128).The difference in distribution ratio of different NTM infected patients was significant among different age group(χ^(2)=25.727,P<0.001)and among people with different residence(χ^(2)=15.227,P=0.002).Multivariate logistic regression analysis showed that M.chelonis/abscess caused milder lung pathologic damage compared with the other two species(OR=0.188,P=0.039).Conclusion The NTM detected in this study were mainly M.intracellular,M.chelonis/abscess and M.kansans,and different NTM caused different degrees of pathological damage in lungs.