重庆市流行非结核分枝杆菌菌种鉴定及感染人群特征
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摘要
目的了解重庆地区非结核分枝杆菌(NTM)流行的优势菌种和NTM感染人群的特征。方法回顾分析2016年7月—2017年12月在重庆市公共卫生医疗救治中心就诊,并经分枝杆菌菌种PCR-反向点杂交法鉴定为NTM和NTM混合感染的患者资料。结果 95例NTM感染病例,单一NTM感染共80例,其中快生长分枝杆菌(RGM)2种,脓肿分枝杆菌31例(38.75%),偶发/猪分枝杆菌14例(17.50%);慢生长分枝杆菌(SGM)5种,胞内分枝杆菌25例(31.25%),鸟分枝杆菌5例(6.25%),戈登分枝杆菌3例(3.75%),堪萨斯分枝杆菌2例(2.50%);分枝杆菌混合感染共15例,其中TB和NTM混合感染11例,NTM混合感染4例。单一NTM感染病例中,男性多于女性,胞内分枝杆菌感染者男性比例最高。而NTM混合感染者中,性别比例均接近1∶1。单一NTM感染者主要集中于20～<30岁和40～<60岁之间,而TB和NTM混合感染者在30～<50岁之间最多。脓肿分枝杆菌感染者主要在20～59岁之间,胞内分枝杆菌感染者主要分布于40～<79岁之间,偶发/猪分枝杆菌的患者集中于60岁以下。结论重庆市NTM的主要流行优势种类以脓肿分枝杆菌和胞内分枝杆菌为主,感染者男性多于女性,以20～<30岁和40～<60岁之间最多,对于不同种类的NTM,感染者的年龄分布和性别比例有所不同。
Objective To analyze the prevailing species nontuberculosis mycobacteria and infected population characteristics in Chongqing. Methods The relative data of the patients who were diagnosed by PCR-reverse dot blot hybridization as NTM infected in Chongqing Infection Disease Medical Center during July 2016 to December 2017 were analyzed retrospectively. Results Among 95 NTM infected strains,80 strains were single infection and 15 strains were mixed infection. In 80 single infection strains, there were 2 species of RGM and 5 species of SGM. RGM were Mycobacterium abscessus(31 strains, 38.75%) and Mycobacterium fortuitum/porcinum(14 strains, 17.50%). SGM were Mycobacterium intracellulare(25 strains, 31.25%), Mycobacterium avium(5 strains, 6.25%), Mycobacterium gordonae(3 strains, 3.75%),Mycobacterium kansasii(2 strains, 2.50%). In the 15 mixed infected strains, 11 strains were co-infected with TB and NTM; 4 strains were two species NTM co-infected. The male patients infected with single NTM were more than the female patients. The gender ratio(male: female) of mix infected patients was nearly 1∶1. The gender ratio(male: female) of Mycobacterium intracellulare infected patients was highest. Single NTM infected patients were major in the ages of 20-<30 and 40-<60,while TB and NTM co-infected patients were most common between the ages of 30-<50. Mycobacterium abscessus infected patients were mainly between 20-<60 years old, and Mycobacterium intracellulare infected patients were mainly distributed among 40-<79 years old. Patients infected by Mycobacterium fortuitum/porcine were mainly under 60 years old. Conclusion Mycobacterium abscessus and Mycobacterium intracellulare were the main prevalent species of NTM in Chongqing. The male NTM infected patients were more than that of the female. NTM infected patients were major in the ages of 20-29 and 40-59.For different species NTM, the age distribution and gender ratio of the infected patients were not the same.
Objective To analyze the prevailing species nontuberculosis mycobacteria and infected population characteristics in Chongqing. Methods The relative data of the patients who were diagnosed by PCR-reverse dot blot hybridization as NTM infected in Chongqing Infection Disease Medical Center during July 2016 to December 2017 were analyzed retrospectively. Results Among 95 NTM infected strains,80 strains were single infection and 15 strains were mixed infection. In 80 single infection strains, there were 2 species of RGM and 5 species of SGM. RGM were Mycobacterium abscessus(31 strains, 38.75%) and Mycobacterium fortuitum/porcinum(14 strains, 17.50%). SGM were Mycobacterium intracellulare(25 strains, 31.25%), Mycobacterium avium(5 strains, 6.25%), Mycobacterium gordonae(3 strains, 3.75%),Mycobacterium kansasii(2 strains, 2.50%). In the 15 mixed infected strains, 11 strains were co-infected with TB and NTM; 4 strains were two species NTM co-infected. The male patients infected with single NTM were more than the female patients. The gender ratio(male: female) of mix infected patients was nearly 1∶1. The gender ratio(male: female) of Mycobacterium intracellulare infected patients was highest. Single NTM infected patients were major in the ages of 20-<30 and 40-<60,while TB and NTM co-infected patients were most common between the ages of 30-<50. Mycobacterium abscessus infected patients were mainly between 20-<60 years old, and Mycobacterium intracellulare infected patients were mainly distributed among 40-<79 years old. Patients infected by Mycobacterium fortuitum/porcine were mainly under 60 years old. Conclusion Mycobacterium abscessus and Mycobacterium intracellulare were the main prevalent species of NTM in Chongqing. The male NTM infected patients were more than that of the female. NTM infected patients were major in the ages of 20-29 and 40-59.For different species NTM, the age distribution and gender ratio of the infected patients were not the same.
引文
[1]中华医学会结核病学分会.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.
[2] PARTE A C. LPSN-List of Prokaryotic names with Standing in Nomenclature(bacterio.net), 20 years on[J]. International journal of systematic and evolutionary microbiology, 2018, 68(6):1825-1829.
[3] GRIFFITH D E, AKSAMIT T, BROWN-ELLIOTT B A, et al. An official ATS/IDSA statement:diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases[J]. American journal of respiratory and critical care medicine, 2007, 175(4):367-416.
[4]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.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] GRIFFIN I, SCHMITZ A, OLIVER C, et al. Outbreak of tattoo-associated nontuberculous mycobacterial skin infections[J]. Clinical Infectious Diseases, 2018, ciy979-ciy.
[6] PREVOTS D R, MARRAS T K. Epidemiology of human pulmonary infection with nontuberculous mycobacteria:a review[J]. Clinics in chest medicine, 2015, 36(1):13-34.
[7] DAKIC I, ARANDJELOVIC I. Pulmonary isolation and clinical relevance of nontuberculous mycobacteria during nationwide survey in Serbia, 2010-2015[J]. 2018, 13(11):e0207751.
[8] JING H, WANG H, WANG Y, et al. Prevalence of nontuberculous mycobacteria infection, China, 2004-2009[J]. Emerging infectious diseases, 2012, 18(3):527-528.
[9]王黎霞.分枝杆菌分离培养标准化操作程序及质量保证手册[M].北京:人民卫生出版社, 2012.
[10] THOMSON R M, CENTRE N T M W G A Q T C, QUEENSLAND MYCOBACTERIAL REFERENCE L. Changing epidemiology of pulmonary nontuberculous mycobacteria infections[J]. Emerging infectious diseases, 2010, 16(10):1576-1583.
[11]中华医学会结核病学分会.非结核分枝杆菌病实验室诊断专家共识[J].中华结核和呼吸杂志, 2016, 39(6):438-443.
[12] VINNARD C, LONGWORTH S, MEZOCHOW A, et al. Deaths Related to nontuberculous mycobacterial infections in the United States, 1999-2014[J]. Annals of the American Thoracic Society,2016, 13(11):1951-1955.
[13] RINGSHAUSEN F C, WAGNER D, DE ROUX A, et al. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany,2009-2014[J]. Emerging infectious diseases, 2016, 22(6):1102-1105.
[14]吕小林,聂益军,林慧,等.基于PCR-反向点杂交法对江西地区分枝杆菌感染状况分析[J].临床肺科杂志, 2017, 22(12):2252-2254.
[15]黄海荣.非结核分枝杆菌的菌种鉴定技术[J].中国医刊, 2016, 51(3):136-139.
[16]余雅,刘英,胡代玉,等. 2009-2013年重庆市肺结核疫情特征分析[J].中国防痨杂志, 2014, 36(12):1036-1042.
[17]王晓英,刘洁,余锋平,等.重庆市复治涂阳肺结核患者耐药分析[J].中国热带医学, 2018, 18(6):572-575.
[18]张文,胡代玉,刘英,等.重庆市638例肺结核患者耐药流行现状分析[J].中国热带医学, 2017, 17(3):231-235.
[19]张洁,苏建荣,丁北川,等.北京地区非结核分枝杆菌菌种分布及耐药性研究[J].中华结核和呼吸杂志, 2017, 40(3):210-214.
[20]罗春明,邹桂敏,刘国标,等.广州市2003-2012年非结核分枝杆菌菌种鉴定结果分析[J].结核病与肺部健康杂志, 2014, 3(1):15-20.
[21]张鑫,蔡静,姜元,等. 43株甘肃临床分离非结核分枝杆菌分类鉴定[J].中国人兽共患病学报, 2017, 33(2):173-177.
[22]潘爱珍,吴蓓蓓,柳正卫,等.浙江省非结核分枝杆菌病原谱的分析[J].中国卫生检验杂志, 2015, 25(24):4298-4300.
[23]王斌,李群,白锐,等.自贡市44株临床非结核分枝杆菌的鉴定[J].中国预防医学杂志, 2018, 19(5):365-367.
[24]吴亦斐,刘伟,谢捷,等.杭州地区流行非结核分枝杆菌鉴定、易感因素和耐药性分析[J].中国人兽共患病学报, 2017, 33(10):882-887.
[2] PARTE A C. LPSN-List of Prokaryotic names with Standing in Nomenclature(bacterio.net), 20 years on[J]. International journal of systematic and evolutionary microbiology, 2018, 68(6):1825-1829.
[3] GRIFFITH D E, AKSAMIT T, BROWN-ELLIOTT B A, et al. An official ATS/IDSA statement:diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases[J]. American journal of respiratory and critical care medicine, 2007, 175(4):367-416.
[4]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.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] GRIFFIN I, SCHMITZ A, OLIVER C, et al. Outbreak of tattoo-associated nontuberculous mycobacterial skin infections[J]. Clinical Infectious Diseases, 2018, ciy979-ciy.
[6] PREVOTS D R, MARRAS T K. Epidemiology of human pulmonary infection with nontuberculous mycobacteria:a review[J]. Clinics in chest medicine, 2015, 36(1):13-34.
[7] DAKIC I, ARANDJELOVIC I. Pulmonary isolation and clinical relevance of nontuberculous mycobacteria during nationwide survey in Serbia, 2010-2015[J]. 2018, 13(11):e0207751.
[8] JING H, WANG H, WANG Y, et al. Prevalence of nontuberculous mycobacteria infection, China, 2004-2009[J]. Emerging infectious diseases, 2012, 18(3):527-528.
[9]王黎霞.分枝杆菌分离培养标准化操作程序及质量保证手册[M].北京:人民卫生出版社, 2012.
[10] THOMSON R M, CENTRE N T M W G A Q T C, QUEENSLAND MYCOBACTERIAL REFERENCE L. Changing epidemiology of pulmonary nontuberculous mycobacteria infections[J]. Emerging infectious diseases, 2010, 16(10):1576-1583.
[11]中华医学会结核病学分会.非结核分枝杆菌病实验室诊断专家共识[J].中华结核和呼吸杂志, 2016, 39(6):438-443.
[12] VINNARD C, LONGWORTH S, MEZOCHOW A, et al. Deaths Related to nontuberculous mycobacterial infections in the United States, 1999-2014[J]. Annals of the American Thoracic Society,2016, 13(11):1951-1955.
[13] RINGSHAUSEN F C, WAGNER D, DE ROUX A, et al. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany,2009-2014[J]. Emerging infectious diseases, 2016, 22(6):1102-1105.
[14]吕小林,聂益军,林慧,等.基于PCR-反向点杂交法对江西地区分枝杆菌感染状况分析[J].临床肺科杂志, 2017, 22(12):2252-2254.
[15]黄海荣.非结核分枝杆菌的菌种鉴定技术[J].中国医刊, 2016, 51(3):136-139.
[16]余雅,刘英,胡代玉,等. 2009-2013年重庆市肺结核疫情特征分析[J].中国防痨杂志, 2014, 36(12):1036-1042.
[17]王晓英,刘洁,余锋平,等.重庆市复治涂阳肺结核患者耐药分析[J].中国热带医学, 2018, 18(6):572-575.
[18]张文,胡代玉,刘英,等.重庆市638例肺结核患者耐药流行现状分析[J].中国热带医学, 2017, 17(3):231-235.
[19]张洁,苏建荣,丁北川,等.北京地区非结核分枝杆菌菌种分布及耐药性研究[J].中华结核和呼吸杂志, 2017, 40(3):210-214.
[20]罗春明,邹桂敏,刘国标,等.广州市2003-2012年非结核分枝杆菌菌种鉴定结果分析[J].结核病与肺部健康杂志, 2014, 3(1):15-20.
[21]张鑫,蔡静,姜元,等. 43株甘肃临床分离非结核分枝杆菌分类鉴定[J].中国人兽共患病学报, 2017, 33(2):173-177.
[22]潘爱珍,吴蓓蓓,柳正卫,等.浙江省非结核分枝杆菌病原谱的分析[J].中国卫生检验杂志, 2015, 25(24):4298-4300.
[23]王斌,李群,白锐,等.自贡市44株临床非结核分枝杆菌的鉴定[J].中国预防医学杂志, 2018, 19(5):365-367.
[24]吴亦斐,刘伟,谢捷,等.杭州地区流行非结核分枝杆菌鉴定、易感因素和耐药性分析[J].中国人兽共患病学报, 2017, 33(10):882-887.