梅琳 刘盛盛 林文红 张妍蓓

摘要：目的 分析安徽省胸科醫院非结核分枝杆菌（NTM）肺病的菌种分布、临床特点及耐药情况，为NTM肺病防治策略的制定和调整提供参考。方法 选取2021年1月到2022年3月在安徽省胸科医院就诊的呼吸道标本酸性罗氏培养阳性且鉴定为NTM的患者，收集其临床资料，回顾性分析NTM肺病菌种分布、临床特点及耐药情况。结果 分枝杆菌培养阳性菌株共3690株，经菌种鉴定为NTM 302株，分离率为8.2%。其中占比最高的为胞内分枝杆菌（74.5%），其次为脓肿分枝杆菌（13.58%）和堪萨斯分枝杆菌（7.62%）。最终诊断为NTM肺病237例。胞内分枝杆菌肺病老年患者占比高于其他NTM肺病患者（62.4% vs. 42.9%，P ＜ 0.05）。NTM肺病的临床表现不具特异性，但进一步分析发现胞内分枝杆菌肺病合并慢性阻塞性肺疾病（COPD）占比高于其他NTM肺病（16.6% vs. 5.4%，P＜0.05）。除堪萨斯分枝杆菌外，其他NTM对一线抗结核药物的耐药率较高，但对阿米卡星、克拉霉素的耐药率低。此外，不同NTM菌种对抗菌药物的耐药性存在一定差异。结论 安徽地区NTM分离菌种以胞内和脓肿分枝杆菌为主，胞内分枝杆菌肺病与其他NTM肺病在人口学特点、临床特征和耐药性上具有一定的不同之处，NTM对常用抗结核药物具有较高的耐药性。本项研究为安徽地区NTM肺病防控和临床治疗用药选择提供了参考，具有临床指导价值。

关键词：非结核分枝杆菌；菌种鉴定；流行病学；临床特征；耐药性

中图分类号：R978文献标志码：A

Analysis of strain distribution， clinical characteristics and drug resistance of non-tuberculous Mycobacterium pulmonary disease in Anhui Chest Hospital

Mei Lin 1， 2， Liu Shengsheng 2， Lin Wenhong2， and Zhang Yanbei1

（1 The First Affiliated Hospital of Anhui Medical University， Hefei 230022;

2 Anhui Chest Hospital， Hefei 230022）

Abstract Objective The strain distribution， clinical characteristics and drug resistance of nontuberculous Mycobacterium （NTM） pulmonary disease in Anhui Chest Hospital were analyzed to provide reference for the formulation and adjustment of prevention and treatment strategies of NTM pulmonary disease. Methods Patients with positive acid roentgen culture of respiratory specimens and identified as NTM attending Anhui Chest Hospital from January 2021 to March 2022 were selected， and the distribution， clinical characteristics and drug resistance of NTM pulmonary disease were retrospectively analyzed. Results A total of 3690 culture-positive strains of Mycobacterium were identified as 302 strains of NTM by strain identification， with an isolation rate of 8.2%. The highest percentage of these was Mycobacterium intracellulare （74.5%）， followed by Mycobacterium abscessus （13.58%） and Mycobacterium kansasii （7.62%）. The final diagnosis of NTM pneumopathy was 237 cases. The proportion of elderly patients with intracellular mycobacterial lung disease was higher than that of patients with other NTM lung diseases （62.4% vs. 42.9%， P<0.05）. The clinical presentation of NTM lung disease was not specific， but further analysis revealed that the proportion of intracellular mycobacterial lung disease combined with chronic obstructive pulmonary disease （COPD） was higher than that of other NTM lung diseases （16.6% vs. 5.4%， P<0.05）. Except for Mycobacterium kansasii， the resistance rate to first-line antituberculosis drugs was higher in other NTM， but low in amikacin and clarithromycin. In addition， there were some differences in the resistance of different NTM strains to antibacterial drugs. Conclusion The NTM isolates in Anhui area are mainly Mycobacterium intracellular and Mycobacterium abscessus， and the Mycobacterium intracellular pneumonia has certain differences from other NTM pulmonary diseases in terms of demographic characteristics， clinical features and drug resistance， and NTM has a high resistance to commonly used anti-tuberculosis drugs. This study provides a reference for the prevention and control of NTM lung disease and clinical treatment drug selection in Anhui， and has clinical guidance value.

Key words Non-tuberculous mycobacteria; Strain identification; Epidemiology; Clinical characteristics;

Drug resistance

非结核分枝杆菌（non-tuberculous Mycobacteria，NTM）是指除结核分枝杆菌复合群和麻风分枝杆菌外的一大类分枝杆菌的总称，至今已发现NTM菌种约190余种[1]。……