结核病专科非结核分枝杆菌肺病菌种分布及病例特点研究

目的 研究309医院结核病研究所接收的肺病病人中非结核分枝杆菌(NTM)肺病的菌种分布及病例特点,为临床诊断提供思路。方法 收集309医院结核病研究所临床实验室2014年9月至2018年3月非结核分枝杆菌阳性报告,根据2012年版中华医学会《非结核分枝杆菌病诊断与治疗专家共识》建立确诊NTM肺病组,研究NTM肺病组中NTM的分布特点;根据NTM肺病组病例的年龄、性别、地域和发病时限建立配对肺结核组,研究两组病人基础状态的差别。结果 NTM阳性108例,分离率为4.66%。确诊NTM肺病72例,分离率为3.10%,90%病例来自华北和东北地区。包括胞内分枝杆菌(33/72, 45.8%),龟/脓肿分枝杆菌(27/72, 37.5%),鸟分枝杆菌(7/72, 9.7%),堪萨斯分枝杆菌(3/72, 4.2%),蟾蜍分枝杆菌(2/72, 2.8%)。NTM肺病患者明确诊断用时平均27.8±30.8个月;平均年龄64.1±18.0岁;男女比例1.88∶1;>80岁组全部为男性,11/13为龟/脓肿分枝杆菌肺病;NTM肺病患者的基础性呼吸系统慢性疾病发生率高于肺结核病患者,差异有统计学意义(χ²=4.141,P=0.042);女性NTM肺病的基础性支气管扩张发生率显著高于男性NTM肺病患者(χ²=10.277,P=0.006)。龟/脓肿分枝杆菌肺病平均年龄75.2±14.8岁,胞内NTM肺病患者平均年龄59.9±17.0岁,这两种肺病的年龄分布差异有统计学意义(χ²=14.832,P=0.011)。结论 华北东北地区主要的NTM肺病致病菌是胞内分枝杆菌和龟/脓肿分枝杆菌;40岁之后NTM肺病发病率随年龄增多;80岁之后以龟/脓肿分枝杆菌为主;女性NTM肺病发病年龄相对小,基础性支气管扩张是女性NTM肺病的易感因素;NTM肺病明确诊断用时长,分枝杆菌核酸检验可以显著提高诊断效率。

Strains and case characteristics of non-tuberculous mycobacterium lung diseases in tuberculosis special department

To study strains and case characteristics of NTM lung diseases in patients from Tuberculosis Research Institute of 309 Hospital, and to provide diagnostic ideas for doctors, NTM-positive reports from September 2014 to March 2018 were collected from the Tuberculosis Research Institute of 309 Hospital. According to the Consensus on the Diagnosis and Treatment of Non-tuberculous Mycobacterial Diseases published by Chinese Medical Association in 2012, NTM lung disease group was established, and the strains characteristics of NTM were studied. The paired pulmonary tuberculosis group was established according to the age, sex, geographical location and duration of the NTM lung disease group. The underlying state of the two groups was analysed. Results showed that 108 cases were positive for NTM, and the separation rate was 4.66%. Seventy-two patients with NTM lung disease were confirmed, the separation rate was 3.10%. Mycobacterium intracellulare (33/72, 45.8%), M. chelonae/abscessus (27/72, 37.5%), M. avium (7/72, 9.7%), M. kansasii (3/72, 4.2%), and M. xenopi (2/72, 2.8%) were included. The patients’ average diagnostic time was 27.8±30.8 months, average age was 64.1±18.0 years; the ratio of males to females was 1.88 overall, but 0.79 in the <60 age group. All the patients in the >80 age group were male, and 11/13 patients were of M. chelonae/abscessus. The underlying incidence of chronic respiratory diseases in patients with NTM lung disease was higher than that of patients with pulmonary tuberculosis, the difference was statistically significant (χ²=4.141, P=0.042). The underlying incidence of bronchiectasis was significantly higher in female NTM lung diseases than that in male patients (χ²=10.277, P=0.006). The mean age of patients with M. chelonae/abscessus lung diseases was 75.2±14.8, which was significantly different (χ²=14.832, P=0.011) from that of patients with M. intracellulare lung disease which was 59.9±17.0. In conclusion, the main pathogens of NTM lung disease in North China and Northeast China are M. intracellulare and M. chelonae/abscessus. The incidence of NTM lung disease increases with age after 40 years old. M. chelonae/abscessus is the most common pathogen after 80 years old. The female patients are young, indicating bronchiectasis is a predisposing factor. NTM lung disease has long diagnosis duration, and mycobacterial nucleic acid test can significantly improve the diagnostic efficiency.