海南省肺部感染患者非结核分枝杆菌的菌种鉴定分析

  目的   通过对海南省肺部感染患者非结核分枝杆菌（NTM）进行菌种鉴定，探讨海南省NTM肺部感染菌种的类型及人群分布情况。  方法   收集2016年7月至2021年6月期间就诊于海南医学院第二附属医院疑似肺结核患者的呼吸道标本进行分枝杆菌培养，对培养阳性标本进行对硝基苯甲酸（PNB）/噻吩-2-羧酸肼（TCH）培养菌型初步鉴定，采用DNA微阵列芯片技术进行分枝杆菌菌种鉴定，无法确定菌种的菌株进一步采用基因测序法鉴定。  结果   共收集8 507例疑似肺结核患者的呼吸道标本，剔除重复病例后，有318例经PNB/TCH培养初步鉴定为NTM，315例经DNA微阵列芯片技术和热休克蛋白65（hsp65）基因测序鉴定为NTM。 其中308例患者为单一感染模式，6例MTB＋NTM和1例2种不同NTM的混合感染模式。快速生长分枝杆菌128株占40.5%，以龟/脓肿分枝杆菌为主（占32.9%）；缓慢生长分枝杆菌188株占59.5%，以胞内分枝杆菌为主（占39.6%）。 女性患者多于男性且好发于中老年人，男女性别比为0.79∶1。 男女性患者年龄分布差异有统计学意义（Z=2.200，P<0.05），>40岁的患者占91.1%。  结论   海南省NTM肺部感染主要以龟/脓肿分枝杆菌、胞内分枝杆菌感染为主，>40岁的女性中老年人为NTM侵袭的主要人群。

Species identification of non-tuberculous Mycobacteria from patients with pulmonary infection in Hainan

  Objective   To identify the non-tuberculous Mycobacteria (NTM) detected in patients with pulmonary infection and discuss the types and population distribution of NTM pulmonary infection in Hainan province.   Methods   The respiratory tract samples of the patients with suspected pulmonary tuberculosis who visited the Second Affiliated Hospital of Hainan Medical College from July 2016 to June 2021 were collected for Mycobacteria culture, and the culture-positive samples were preliminarily identified by P-Nitrobenzoic acid (PNB)/2-Thiophenecarboxylic acid hydrazide (TCH) culture using DNA microarrays. Microarray technology was used to identify Mycobacterium species, and gene sequencing was used to further identify strains that could not be identified.   Results   A total of 8 507 respiratory tract samples from suspected pulmonary tuberculosis patients were collected during the study period. After excluding duplicated cases, 318 cases were preliminarily identified as NTM infection by PNB/TCH culture, and 315 cases were identified as NTM infection by DNA microarray chip technology and heat shock proteins 65 (hsp65) gene sequencing. Among them, 308 patients had a single infection pattern, 6 had MTB+NTM infection and 1 had a mixed infection of two different NTMs. There were 128 strains of rapidly growing Mycobacteria (RGM), accounting for 40.5%, mainly Mycobacterium chelonae/abscessus (32.9%); and 188 strains of slow growing Mycobacteria (SGM), accounting for 59.5%, with Mycobacterium intracellulare as the main strain (39.6%). More infection occurred in women than in men, especiadlly in middle-aged and elderly women, the male-to-female ratio of the cases was 0.79∶1. The difference in age distribution of the cases between men and women was significant (Z=2.200, P<0.05), and 91.1% of the cases were older than 40 years old.   Conclusion   In Hainan, NTM pulmonary infection was mainly caused by Mycobacterium chelonae/abscessus and Mycobacterium intracellulare, and the middle-aged and elderly women aged ＞40 years were the main populations affected by NTM.