手部慢性特殊感染病灶中分支杆菌的检测

目的探讨应用Nest-PCR检测技术对普通细菌培养阴性的手部慢性特殊感染患者提供有效的诊治依据。方法对15例手部慢性特殊感染病灶，除一般的病理、普通及特殊细菌培养、直接抗酸染色检查外，应用Nest-PCR技术来检测感染病灶中的分支杆菌，并对分支杆菌进行核酸测序分型。结果15例中普通及特殊细菌培养、直接抗酸染色均呈阴性。病理检查：结核性肉芽肿1例，结核样肉芽肿3例，结节性肉芽肿4例，慢性肉芽肿性炎7例。应用Nest—PCR检测技术，测出9例为非结核分支杆菌(Non-tuberculous myrcobacterium，NTM)阳性，结核杆菌为0。经核酸测序分型属海分支型5例，堪萨斯／胃型2例，鸟分支型1例，龟／脓肿型1例。结论Nest-PCR检测弥补了肺外分支杆菌培养阳性率低下的缺陷，证实了NTM感染，尤其是海分支杆菌远比结核菌常见，是沿海地区手部慢性特殊感染的主要致病因素。

Detection of mycobacterium from focus of infection in special chronic hand infections

Objective To evaluate the application of Nest-PCR techniques in diagnosing special chronic hand infections which have negative routine bacterial culture results. Methods 15 cases of chronic hand infections were involved in this study. Samples from foci of infection were taken for histological observation, routine and specific culture, acid-fast staining, and Nest-PCR. Gene sequencing was also applied to identify Mycobacterium species. Results All 15 cases had negative routine and specific culture results. Acid-fast staining was also negative. Histological examination revealed tuberculous granuloma in 1 case, tuberculoid granuloma in 3 cases, nodular granuloma in 4 cases, and chronic granulomatous tissue in 7 cases. 9 of 15 cases were positive of non-tuberculous mycobacterium by Nest-PCR, among which five were M.marinum, two were M.kansasii/Gastri, one was M.avium, and another one was M.chelonae/abscessus. Conclusion Nest-PCR is an effective method to detect mycobacterium from foci of infection that is culturing negative. Non-tuberculous mycobacterium (NTM) is the major pathogen of special chronic hand infections in populations of coast areas.