非结核分枝杆菌肺病临床分离株的菌种鉴定及临床特征分析

为探究非结核分枝杆菌（nontuberculous mycobacterium，NTM）肺病临床分离株的菌种分布及临床特征， 对2017年5月―2018年10月就诊于复旦大学附属中山医院的90例NTM肺病患者的样本进行分析。采用快速全自动分枝杆菌培养和药物敏感检测系统（BACTEC MGIT960 System）或改良罗氏培养法对90例患者的采集样本进行培养，利用基质辅助激光解析/电离飞行时间质谱（matrix assisted laser desorption/ionization time of flight mass spectrometry，MALDI-TOF MS）进行菌种鉴定，并对回顾性分析收集的90例患者的临床资料进行分析。结果NTM菌种鉴定为9种，其中慢速生长分枝杆菌65例，以胞内分枝杆菌（54.4%，49/90）占多数；快速生长分枝杆菌25例，以脓肿分枝杆菌（22.2%，20/90）占多数。90例患者中确诊67例、疑似23例。确诊患者中少见菌种所占比例较低（6.0% vs 26.1%，P = 0.016）。确诊与疑似患者在临床表现方面未见显著差异，但确诊患者有抗NTM治疗史的比例显著高于疑似患者（85.1% vs 4.3%，P < 0.001）。确诊患者中，快速生长NTM肺病患者既往抗结核治疗史的比例显著高于慢速生长组（52.9% vs 24.0%，P = 0.036）。本研究结果为NTM肺病的临床诊治提供了数据参考。

Identification and clinical analysis of nontuberculous mycobacterium lung disease

To analyze the strain distribution and clinical characteristics of nontuberculous mycobacteria (NTM) lung disease in Shanghai, a total of 90 samples from patients with NTM lung disease from Zhongshan Hospital, Fudan University from May 2017 to October 2018 were cultured by rapid automated mycobacterial culture and drug sensitive detection system (BACTEC MGIT960 System) or modified Roche culture method and identified by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). The clinical data of patients were retrospectively collected. NTM strains were identified as 9 species, 65 cases of slow-growth NTM, most of which were Mycobacterium intracellulare (54.4%, 49/90); 25 cases of rapid-growth NTM, most of which were Mycobacterium abscessus (22.2%, 20/90). 67 cases were confirmed, 23 were suspected. The proportion of rare NTM in the confirmed patients was lower (6.0% vs 26.1%, P = 0.016). There was no significant difference in clinical manifestations between confirmed and suspected patients, but the proportion of confirmed patients with anti-NTM treatment history was significantly higher than that of suspected patients (85.1% vs 4.3%, P <0.001). Among the confirmed patients, the proportion of patients with rapid-growth NTM lung disease who had previous anti-tuberculosis treatment was significantly higher than that of the slow-growth group (52.9% vs 24.0%, P = 0.036). The results of this study provide a data reference for the clinical diagnosis and treatment of NTM lung disease.