233例非结核分枝杆菌肺病的临床分析.docVIP

233例非结核分枝杆菌肺病的临床分析 　　【摘要】 目的：了解江门市非结核分枝杆菌（NTM）感染流行情况和临床特点。方法：以2005-2013年经过痰培养和鉴定而诊断的233例非结核分枝杆菌肺病患者为本次研究对象，进行回顾性分析。结果：NTM检出率逐渐升高，近年达10.6%。药敏试验分析显示，NTM对多种抗结核药物的耐药率很高。异烟肼和利福平耐药率达97.8%和92.4%。对莫西沙星、克拉霉素及利福布汀耐药性较低，分别为44.6%、29.3%和29.3%。咳嗽咳痰及咯血是最常见的症状，女性和老年患者多见，超过半数患者合并支气管扩张，易误诊为肺结核。结论：非结核分枝杆菌耐药情况比较严重，分枝杆菌菌型鉴定和药敏试验检测对临床诊治有重要的指导性。克拉霉素和利福布汀是比较有效的治疗药物。 　　【关键词】 分枝杆菌； 非结核分枝杆菌； 药敏试验； 耐药； 回顾性研究 　　【Abstract】 Objective： To analyze the epidemic trends and clinical characteristic of nontuberculous mycobacteria （NTM） infection in Jiangmen City. Method： A total of 233 NTM lung diseases diagnosed by bacteria culture and identify from 2005 to 2013 were retrospectively analyzed in the study. Result： The detected rate of NTM was increasing gradually to 10.6%. According to the drug susceptibility test， NTM were resistant to many antitubercular agents. The resistant rates were 97.8% of Isoniazid and 92.4% of Rifampicin. New drugs as Moxifloxacin， Clarithromycin and Rifabutin exhibited more potent in vitro antimycobacterial activities. The resistant rate was 44.6%， 29.3% and 29.3%， respectively. NTM lung diseases were often developed in the female group and the elderly patients. The most common symptoms were cough， expectoration and hemoptysis. More than half of the cases were combined with bronchiectasia. NTM lung disease were easily misdiagnosed as tuberculosis. Conclusion： Drug resistance of NTM in local region is serious. The mycobacteria identify and drug susceptibility test play an important role in the diagnosis and therapy of NTM infection. Clarithromycin and Rifabutin are considered to be active against NTM. 　　【Key words】 Mycobacteria； Nontuberculous mycobacteria； Drug susceptibility； Resistant； Retrospective study 　　First-author’s address： Jiangmen Institute of Tuberculosis Prevention and Control， Jiangmen 529000， China 　　doi：10.3969/j.issn.1674-4985.2015.13.036 　　非结核分枝杆菌（NTM）是指结核杆菌及麻风分枝杆菌以外的所有分枝杆菌。非结核分枝杆菌病是指人类感染NTM所引起相关组织或脏器的病变。全球的流行疫情逐渐升高，在不少国家和地区已成为威胁人类健康的重要公共卫生问题[1-3]