广州市旧城区1994-2003年非结核分枝杆菌流行状况分析

目的 探讨近10年广州市旧城区非结核分枝杆菌(MOTT)流行状况及流行趋势。方法分析1994-2003年广州市结核病肺部肿瘤防治所结核专科门诊患者的分枝杆菌培养、分群鉴定、部分MOTT菌株耐药性测定及菌种鉴定情况。结果检出12634株分枝杆菌，其中MOTT 794株，其分离率为6．28％，年分离率3．51％～10．06％，10年上升幅度为73．15％；对613株MOTT进行异烟肼(H)、利福平(R)、链霉素(SM)和乙胺丁醇(EMB)4种主要抗结核药物耐药性测定，至少耐R和H的菌株512株，耐多药率为83．5％，各年耐多药率71．4％～93．9％；菌种分布主要为致病性鸟-胞内、龟-脓肿分枝杆菌和瘰疬、偶发分枝杆菌等条件致病性MOTT；45岁以上年龄组为MOTT易感人群，55～65岁为感染高峰，男女性别构成平均为3．36：1。结论10年来，广州市旧城区人口MOTT流行情况及长期变异趋势和全国水平相当，但分离率呈大幅上升趋势，主要为致病性菌种，并具有极高的耐药率，故对MOTT致病的流行病学研究应纳入国家结核病控制规划。

Analysis on the current situation of Mycobacteria other than tuberculosis during 1994- 2003 in the old city area of Guangzhou

Objective To analyze the current situation and trend of Mycobacteria other than tuberculosis(MOTT) in the old city area of Guangzhou and to provide information for diagnosis, treatment and policy on tuberculosis(TB) control in the city. Methods Relevant data regarding Mycobacteria culture, species identification and drug-resistance from out-patients under suspicion of having pulmonary tuberculosis seen at our TB and Pulmonary Tumor Control Institute, was analyzed retrospectively during 1994-2003. Results A total number of 12 634 strains of Mycobacteria were isolated and 794 strains were identified as MOTT which accounted for 6.28% of the isolated strains during the ten years. The annual isolation rates of MOTT were between 3.51% and 10.06%. When compared with 1994, the rates of isolation on MOTT had increased 73.15% in 2003, i.e. from 5.81% in 1994 to 10.06% in 2003. 512 strains were not susceptible at least to rifampin and isoniazid out of 613 MOTT strains tested for drug susceptibility to isoniazid, rifampin, streptomycin sulfate and ethambutol. The average rate of multi-drugs resistance of these strains was 83.5%, and the annual rates were between 71.4% and 93.9%. Based on the results of species identification on 136 strains of MOTT in 2003, most of them belonged to pathogenic/opportunistic species of Mycobacteria. All together, 30 strains of M.abscessus, 26 of M.intracellulare, 17 of M.smegmatis, 14 of M.scrofulaceum, 11 of M.avium, 5 of M.kansasii and M.chelonae and M.fortuitum respectively, 4 of M.nonchromogenicum, 2 of M.triviale and 1 of M.aurum were identified. People at 45 years of age or older, with 55-65 the most, were more susceptible to MOTT than other age groups. Sex ratio was 3.36 to 1. Conclusion Based on information from the Third National Tuberculosis Epidemiology Survey in 1990 and the Fourth one in 2000, the current situation and trend of MOTT were nearly the same in the old city area of Guangzhou during 1994-2003. However, the rising tendency of rate of isolation, mainly consisted of opportunistic pathogens and the surprisingly high rate of multi-drugs resistance to MOTT all call for special attention. Studies regarding the epidemiology of MOTT should be posed and implemented in the National TB Control Program.