诊断学理论与实践

诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (04): 450-455.doi: 10.16150/j.1671-2870.2022.04.006

• 论著 • 上一篇    下一篇

2012年至2021年上海市艾滋病合并分枝杆菌感染患者的菌种分布特征

胡静静1,2, 吕海伟1,2, 荀静娜2, 沈银忠2, 刘莉2(), 卢洪洲1,3()   

  1. 1.蚌埠医学院公共卫生学院,安徽 蚌埠 233000
    2.复旦大学附属公共卫生临床中心感染与免疫科,上海 201508
    3.南方科技大学第二附属医院（深圳市第三人民医院）,广东 深圳 518000
  • 收稿日期:2022-04-01 出版日期:2022-08-25 发布日期:2022-11-07
  • 通讯作者: 刘莉,卢洪洲 E-mail:liuli@shphc.org.cn;luhongzhou@fudan.edu.cn
  • 基金资助:
    上海市感染性疾病（艾滋病）临床医学研究中心项目(20MC1920100);上海市临床重点专科项目-传染病科(shslczdzk 01102)

Characteristcs of mycobacterial species distribution in acquired immunodeficiency syndrome patients with mycobacterial infection in Shanghai

HU Jingjing1,2, LÜ Haiwei1,2, XUN Jingna2, SHEN Yinzhong2, LIU Li2(), LU Hongzhou1,3()   

  1. 1. School of Public Health, Bengbu Medical College, Anhui Bengbu 233000, China
    2. Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
    3. The Second Affiliated Hospital of Southern University of Science and Technology (The Third People’s Hospital of Shenzhen), Guangdong Shenzhen 518000, China
  • Received:2022-04-01 Online:2022-08-25 Published:2022-11-07
  • Contact: LIU Li,LU Hongzhou E-mail:liuli@shphc.org.cn;luhongzhou@fudan.edu.cn

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摘要：

目的：分析上海市艾滋病合并分枝杆菌感染患者的菌种分布特征。方法：收集2012年1月1日至2021年12月31日间上海市公共卫生临床中心9 619例门诊及住院艾滋病且有分枝杆菌培养记录的患者,获取培养阳性者的分离菌株,采用结核菌群特异性分泌蛋白MPB64免疫胶体金法或分枝杆菌测序（16S rDNA）法鉴定菌种,分析艾滋病合并分枝杆菌感染患者的菌种分布特征。结果：艾滋病合并分枝杆菌培养阳性患者共1 478例（15.4%）,其中有菌种鉴定结果的患者1 367例。结核分枝杆菌复合群（Mycobacterium tuberculosis complex,MTBC）患者为494例（36.1%）,非结核分枝杆菌（non-tuberculous mycobacteria,NTM）患者838（61.3%）例,MTBC兼NTM混合感染患者35例（2.6%）。2012年至2021年的分枝杆菌培养阳性病例中,鉴定为NTM（不包含MTBC兼NTM混合感染患者）的构成比逐年分别为55.2%（53/96）、65.5%（78/119）、66.2%（90/136）、55.1%（70/127）、61.6%（93/151）、66.1%（111/168）、58.9%（99/168）、61.8%（94/152）、63.6%（77/121）、56.6%（73/129）。MTBC感染患者、NTM感染患者及MTBC兼NTM混合感染患者的组织标本均以痰液为主,痰液标本构成比为68.0%（336/494）、78.0%（654/838）和88.6%（31/35）,其次为血液。1 271例分枝杆菌培养阳性患者为感染与免疫科收治,其中NTM占比为58.5%（743/1 271）。结论：在2012年至2021年间,上海市艾滋病患者合并分枝杆菌培养阳性率为15.4%（1 478/9 619）,其中历年NTM构成比高于MTBC,临床医师需高度重视NTM的诊治。

关键词: 人类免疫缺陷病毒/获得性免疫缺陷综合征, 结核分枝杆菌, 非结核分枝杆菌

Abstract:

Objective: To analyze the distribution of mycobacterium(MB) species in patients with AIDS and with MB. Methods: From January 1, 2012 to December 31, 2021, a total of 9 619 outpatients and inpatients with AIDS and with mycobacterial culture in the Shanghai Public Health Clinical Center were enrolled. The clinical data of those with positive culture of MB were analyzed, and the isolated strains were obtained. The strains were identified using the immunocolloidal gold method of MPB64, a specific secreted protein of tubercle bacilli, or mycobacterial sequencing (16S rDNA) method, and the distribution characteristics of strains in AIDS patients with MB infection were analyzed. Results: A total of 1 478 patients got a positive result of MB culture and among them, 1 367 patients obtained an identified strain species result, including 494 (36.1%) cases of mycobacterium tuberculosis complex (MTBC), 838 (61.3%) cases of non-tuberculous mycobacteria (NTM), and 35 (2.6%) cases of MTBC combined with NTM. The year-by-year composition of NTM (patients with mixed MTBC and NTM infection are not included) from 2012 to 2021 were 55.2%(53/96), 65.5% (78/119), 66.2% (90/136), 55.1% (70/127), 61.6% (93/151), 66.1% (111/168), 58.9% (99/168), 61.8% (94/152), 63.6%(77/121), and 56.6% (73/129). Sputum was the main tissue specimen, accounted for 68.0% (336/494), 78.0% (654/838) and 88.6% (31/35) in patients with MTBC, NTM, mixed MTBC-NTM infection, respectively. One thousand two hundred and seventy-one patients with positive MB culture were admitted to the Department of Infection and Immunology, of which the NTM accounted for 58.5%(743/1 271). Conclusions: From 2012 to 2021, the positive rate of MB culture among AIDS patients in Shanghai is 15.4%(1 478/9 619), of which the composition ratio of NTM are higher than that of MTBC over the years. This suggests that clinicians should pay high attention to the diagnosis and treatment of NTM.

Key words: Human immunodeficiency virus/Acquired immune deficiency syndrome, Mycobacterium tuberculosis, Non-tuberculous mycobacteria

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