云南省非结核分枝杆菌流行状况及病原谱分析

目的 分析云南省非结核分枝杆菌（NTM）流行状况及NTM病原谱和优势菌群,为云南省NTM的有效防治提供参考依据,以适应临床诊治工作需求。方法 对云南省2009、2013—2015年收集的5 406例临床分离分枝杆菌进行结核分枝杆菌复合群（MTC）与NTM鉴别,对鉴定为NTM的菌株进行菌种鉴定。结果 在5 406例临床分离分枝杆菌中共鉴别出NTM菌株87株,其中非结核分枝杆菌患者以男性为主,40岁以上患者多见。20~39岁患者占所有患者的18.39%,40岁以上占80.46%;患者的民族以汉族为主（占80.46%）,其次是彝族（8.05%）。优势流行的菌种前4位为胞内分枝杆菌、脓肿分枝杆菌、鸟分枝杆菌、偶发分枝杆菌,肺结核高中低疫情地区NTM分离率差异有统计学意义,且肺结核疫情与NTM分离率呈负相关。结论 云南省NTM分离率低,肺结核疫情高的地区非结核分枝杆菌分离率低,反之则高,地区差异明显,因此应加强NTM流行状况监测,同时结合优势菌种优化诊治流程,为临床早诊断、早治疗提供帮助。

Analysis of epidemic and pathogenic spectrum on non-tuberculous mycobacteria strains of Yunnan

Objective To analyze the prevalence of pathogenic spectrum and dominant population of non-tuberculosis mycobacteria (NTM) strains in Yunnan Province, and to provide references for the effective prevention and clinical diagnosis. Methods A total of 5 406 clinical isolates of Mycobacterium were collected Yunnan Province in 2009, 2013, 2014 and 2015. These Mycobacterium isolates were identified as M. tuberculosis complex (MTC) and NTM strains by conventional identification method. Then NTM strains were identified for different strains. Results A total of 87 NTM strains were identified from 5 406 clinical Mycobacterium isolates. These patients were mainly male and most of them more than 40 years old. Among all patients, 18.39% were 20-39 years old, and 80.46% were over 40 years old; the ethnic group of the patients was mainly Han, accounting for 80.46%, followed by the Yi, accounting for 8.05%. The top four dominant strains were M.intracellular, M.abscessu, M.avium and M.fortuitum. There was statistical difference in the detection rate of NTM where the epidemic of tuberculosis was high middle and low, and the tuberculosis epidemic was negatively correlated with NTM isolation rate. Conclusions The isolation rate of NTM strains is low in Yunnan Province. Mycobacterium tuberculosis isolation rate is low where tuberculosis epidemic is high, and vice versa. There are a lot of regional differences, so the epidemic condition of NTM monitoring should be strengthened, so as to provide help for clinical early diagnosis and early treatment combine with superiority strains of diagnosis and treatment of optimization process.