福建省非结核分枝杆菌肺病和肺结核病例对照研究
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摘要
目的探讨非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病和结核病的影响因素,为完善结核病和NTM肺病防控策略提供科学依据。方法应用病例对照研究方法对福建省2014年结核病流行病学抽样调查发现的所有NTM肺病和结核分枝杆菌复合群阳性肺结核患者的影响因素比较分析。结果本研究共发现NTM肺病患者16例(30.19%),肺结核患者37例(69.81%)。单因素分析显示,NTM肺病患者与肺结核患者在流调点经济类型、家庭人均收入与当地人均收入的比例、胸片病灶范围比较差异有统计学意义(χ~2=4.16、9.10、9.73,均P<0.05)。多因素分析显示,NTM肺病患者的肺部病灶比较轻微(P<0.05)。结论福建省NTM肺病疫情严重,但未引起充分重视。临床中针对城镇、胸片病灶比较轻微、缺少细菌学依据仅根据临床诊断为肺结核、抗结核治疗疗效不佳的患者,应该尽快通过菌种鉴定进一步明确诊断。
Objective To identify the social and financial factors affecting the non-tuberculosis mycobacterium(NTM)lung disease and tuberculosis,and to provide scientific evidence for disease prevention and control.Methods A case-control study was conducted on NTM and mycobacterium tuberculosis complex found in a tuberculosis epidemiological sampling survey in 2014 in Fujian province. Results 16 cases(30.19%)of NTM and 37 cases(69.81%)of TB were reported.The univariate analysis showed that the prevalence of NTM was higher in urban areas than in rural areas,patients with NTM usually had higher family income and had minor lung lesions compared to those with TB(χ~2=4.16,9.10,9.73,P<0.05).Multivariate analysis showed that lung lesion was minor with NTM than with TB(P<0.05). Conclusions The prevalence of NTM in Fujian province is relatively higher,probably due to the disease negligence of the public.In clinic,for those with minor lung lesion and with poor anti-TB therapeutic effect,it is urgent for NTM diagnosis by bacteria identification.
Objective To identify the social and financial factors affecting the non-tuberculosis mycobacterium(NTM)lung disease and tuberculosis,and to provide scientific evidence for disease prevention and control.Methods A case-control study was conducted on NTM and mycobacterium tuberculosis complex found in a tuberculosis epidemiological sampling survey in 2014 in Fujian province. Results 16 cases(30.19%)of NTM and 37 cases(69.81%)of TB were reported.The univariate analysis showed that the prevalence of NTM was higher in urban areas than in rural areas,patients with NTM usually had higher family income and had minor lung lesions compared to those with TB(χ~2=4.16,9.10,9.73,P<0.05).Multivariate analysis showed that lung lesion was minor with NTM than with TB(P<0.05). Conclusions The prevalence of NTM in Fujian province is relatively higher,probably due to the disease negligence of the public.In clinic,for those with minor lung lesion and with poor anti-TB therapeutic effect,it is urgent for NTM diagnosis by bacteria identification.
引文
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[12]余斐,陈晓,嵇仲康,等.杭州地区2009-2014年非结核分枝杆菌流行状况分析[J].中国微生态学杂志,2016,28(7):808-810,815.
[13]初乃惠.应重视非结核分枝杆菌病的诊治[J].中国医刊,2016,51(3):1-2.
[14]左蕾,吴永红.非结核分枝杆菌与结核分枝杆菌培养阳性患者的临床对比分析[J].新疆医学,2016,46(1):33-35.
[15]张静波,褚海青.非结核分枝杆菌肺病临床特征及其影像学特点[J].中国感染与化疗杂志,2016,16(1):86-91.
[16]董波,王冕.非结核分枝杆菌肺病与肺结核临床特征对比分析[J].现代实用医学,2016,28(4):546-547.
[17]唐神结.非结核分枝杆菌病诊断与治疗专家共识解读[J].中国医刊,2016,51(3):21-24.
[2]刘坦业,江秀文,俞文诚.福建省非结核分枝杆菌感染流行情况[J].中国人兽共患病杂志,1995(1):53-55.
[3]王宇.全国第五次结核病流行病学抽样调查资料汇编[M].北京:军事医学科学出版社,2011.
[4]唐神结.非结核分枝杆菌病诊断与治疗专家共识[J].中华结核和呼吸杂志,2012,35(8):572-580.
[5]周爱萍,贺拥军,孙亚楠,等.西安市非结核分枝杆菌感染现状调查分析[J].中国人兽共患病学报,2015,31(12):1196-1199.
[6]童莉,谭守勇,刘志辉,等.广州市越秀区及海珠区非结核分枝杆菌流行状况[J].实用医学杂志,2015,31(13):2211-2213.
[7]毕晟.浙江地区非结核分枝杆菌在疑似肺结核患者中的流行研究[D].杭州:浙江大学,2015.
[8]Wang HX,Yue J,Han M,et al.Nontuberculous mycobacteria:susceptibility pattern and prevalence rate in Shanghai from 2005to 2008[J].Chin Med J,2010,123(2):184-187.
[9]Lai CC,Tan CK,Chou CH,et al.Increasing incidence of nontuberculous mycobacteria,Taiwan,2000-2008[J].Emerging Infect Dis,2010,16(2):294-296.
[10]黄明翔,万康林,陈力舟,等.福建省临床分离非结核分枝杆菌菌种分布研究[J].中国人兽共患病学报,2014,30(12):1227-1230.
[11]阮祥钊,郑养文.泉州市67例非结核病分枝杆菌感染流行特征[J].海峡预防医学杂志,2015,21(5):94-96.
[12]余斐,陈晓,嵇仲康,等.杭州地区2009-2014年非结核分枝杆菌流行状况分析[J].中国微生态学杂志,2016,28(7):808-810,815.
[13]初乃惠.应重视非结核分枝杆菌病的诊治[J].中国医刊,2016,51(3):1-2.
[14]左蕾,吴永红.非结核分枝杆菌与结核分枝杆菌培养阳性患者的临床对比分析[J].新疆医学,2016,46(1):33-35.
[15]张静波,褚海青.非结核分枝杆菌肺病临床特征及其影像学特点[J].中国感染与化疗杂志,2016,16(1):86-91.
[16]董波,王冕.非结核分枝杆菌肺病与肺结核临床特征对比分析[J].现代实用医学,2016,28(4):546-547.
[17]唐神结.非结核分枝杆菌病诊断与治疗专家共识解读[J].中国医刊,2016,51(3):21-24.