84例非结核分枝杆菌肺病患者临床特征及耐药性分析

doi:10.3969/j.issn.2096-8493.20210054

摘要/Abstract

摘要：

目的分析非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病患者临床特征、菌种分布及对常用抗结核药物的耐药情况。方法采用回顾性研究的方法,按照入组标准收集2016年1月至2021年1月苏州市第五人民医院确诊的84例NTM肺病患者(NTM组)和同期的84例肺结核患者(肺结核组)的临床资料,分析两组患者在既往病史、入院初期的临床症状和影像学表现等方面的差异,并记录NTM分离株的菌种鉴定结果及各菌种对异烟肼、链霉素、对氨基水杨酸、阿米卡星、左氧氟沙星、利福平、乙胺丁醇、丙硫异烟胺等8种常用抗结核药品的耐药性。结果 NTM组患者有慢性呼吸系统疾病[22.6%(19/84)]、发热[27.4%(23/84)]、咳嗽[95.2%(80/84)]、咯血[29.8%(25/84)]、胸闷[40.5%(34/84)]、并发肺部空洞[38.1%(32/84)]、支气管扩张[45.2%(38/84)]及γ-干扰素释放试验阴性[77.4%(65/84)]等方面均明显高于肺结核组[分别为2.4%(2/84)、3.6%(3/84)、57.1%(48/84)、9.5%(8/84)、15.5%(13/84)、21.4%(18/84)、7.1%(6/84)、2.4%(2/84)],差异均有统计学意义(χ²=15.728,P<0.001;χ²=18.202,P<0.001;χ²=38.403,P<0.001;χ²=10.898,P=0.001;χ²=13.028,P<0.001;χ²=5.581,P=0.018;χ²=31.531,P<0.001;χ²=98.536,P<0.001)。84株NTM分离株前3位的菌种依次为:胞内分枝杆菌(58株,69.0%)、堪萨斯分枝杆菌(15株,17.9%)和龟/脓肿分枝杆菌(6株,7.1%)。药物敏感性试验结果显示,84株NTM分离株对8种抗结核药品的耐药率由高到低依次为异烟肼(84株,100.0%)>链霉素(83株,98.8%)>对氨基水杨酸(82株,97.6%)>阿米卡星(77株,91.7%)>左氧氟沙星=利福平(69株,82.1%)>乙胺丁醇(22株,26.2%)>丙硫异烟胺(13株,15.5%)。结论 NTM肺病好发于有慢性呼吸系统疾病的老年患者,γ-干扰素释放试验阴性可早期及时区分NTM肺病和肺结核。NTM对常用抗结核药物耐药率高,治疗难度大,早期诊断并积极进行药物敏感性试验意义重大。

关键词: 分枝杆菌,非典型性, 分枝杆菌,结核, 疾病特征, 细菌分型技术, 微生物敏感性试验

Abstract:

Objective To analyze the clinical characteristics, strain distribution and drug resistance to common anti-tuberculosis drugs in patients with non-tuberculous mycobacteria (NTM) lung disease. Methods The clinical data of 84 patients with NTM lung disease (NTM group) and 84 patients with pulmonary tuberculosis (pulmonary tuberculosis group) diagnosed in Suzhou Fifth People’s Hospital from January 2016 to January 2021 were collected by retrospective analysis according to the inclusion criteria, and the differences between the two groups in previous medical history, clinical symptoms and imaging manifestations at the initial stage of admission were analyzed. The identification results of NTM isolates and the drug resistance of each strain to isoniazid, streptomycin, p-aminosalicylic acid, amikacin, levofloxacin, rifampicin, ethambutol and isonicotinamide were recorded. Results The patients in NTM group had chronic respiratory diseases (22.6% (19/84)), fever (27.4% (23/84)), cough (95.2% (80/84)), hemoptysis (29.8% (25/84)), chest tightness (40.5% (34/84)), with pulmonary cavity (38.1% (32/84)) and bronchiectasis (45.2% (38/84)) and negative γ-interferon release test (77.4% (65/84)) were significantly higher than those of tuberculosis group (2.4% (2/84), 3.6% (3/84), 57.1% (48/84), 9.5% (8/84), 15.5% (13/84), 21.4% (18/84), 7.1% (6/84), 2.4% (2/84)), the differences were statistically significant (χ²=15.728,P<0.001;χ²=18.202,P<0.001;χ²=38.403,P<0.001;χ²=10.898,P=0.001;χ²=13.028,P<0.001;χ²=5.581,P=0.018;χ²=31.531,P<0.001;χ²=98.536,P<0.001).The top three strains of 84 NTM isolates were Mycobacterium intracellular (58 strains, 69.0%), Mycobacterium Kansas (15 strains, 17.9%) and M.chelonicus/abscess (6 strains, 7.1%). According to the results of drug sensitivity test, in this study, the resistance rates of 84 patients with NTM to 8 anti-tuberculosis drugs were INH (84 strains, 100.0%)>Sm (83 strains, 98.8%)>PAS (82 strains, 97.6%)>Am(77 strains, 91.7%)>Lfx=RFP (69 strains, 82.1%)>EMB (22 strains, 26.2%)>Pto (13 strains, 15.5%). Conclusion NTM-PD is common in elderly patients with respiratory diseases, negative γ-interferon release test can distinguish NTM lung disease from pulmonary tuberculosis early and timely. It has a high resistance rate to commonly used anti-tuberculosis drugs and is accompanied by great treatment difficulty. Early diagnosis and active drug sensitivity testing are of great importance.

Key words: Mycobacteria,atypica, Mycobacterial tuberculous, Disease attributes, Bacterial typing techniques, Microbial sensitivity tests

王熠, 陆静, 李苏梅, 朱雪峰, 曾令武. 84例非结核分枝杆菌肺病患者临床特征及耐药性分析[J]. 结核与肺部疾病杂志, 2021, 2(3): 223-227. doi: 10.3969/j.issn.2096-8493.20210054

WANG Yi, LU Jing, LI Su-mei, ZHU Xue-feng, ZENG Ling-wu. Clinical characteristics and drug resistance of 84 patients with non-tuberculous mycobacterium pulmonary disease[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(3): 223-227. doi: 10.3969/j.issn.2096-8493.20210054

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药品	胞内分枝杆菌 (58株)		堪萨斯分枝杆菌 (15株)		龟/脓肿分枝杆菌(6株)		鸟分枝杆菌 (3株)		草分枝杆菌 (1株)		偶然分枝杆菌 (1株)		合计
药品	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)
异烟肼	58	100.0	15	100.0	6	6/6	3	3/3	1	1/1	1	1/1	84	100.0
利福平	56	96.6	2	13.3	6	6/6	3	3/3	1	1/1	1	1/1	69	82.1
乙胺丁醇	12	20.7	1	6.7	6	6/6	2	2/3	0	0/1	1	1/1	22	26.2
链霉素	58	100.0	15	100.0	6	6/6	3	3/3	0	0/1	1	1/1	83	98.8
阿米卡星	57	98.3	9	60.0	6	6/6	3	3/3	1	1/1	1	1/1	77	91.7
左氧氟沙星	55	94.8	3	20.0	6	6/6	3	3/3	1	1/1	1	1/1	69	82.1
对氨基水杨酸	56	96.6	15	100.0	6	6/6	3	3/3	1	1/1	1	1/1	82	97.6
丙硫异烟胺	7	12.1	0	0.0	6	6/6	0	0/3	0	0/1	0	0/1	13	15.5