摘要
目的:探讨皮肤非结核分枝杆菌感染(nontuberculous mycobacteria, NTM)临床特点和诊疗方法,提高对皮肤NTM感染的认识和诊断水平。方法:收集2022年4月至2024年8月西京医院皮肤科门诊皮肤NTM感染疑诊患者57例,统计分析其培养法、抗酸染色和核酸测序检测结果,随访治疗和预后情况。结果:综合病史、临床和实验室检测结果最终诊断皮肤NTM感染34例,男18例(52.94%),女16例(47.06%),发病年龄14~81岁,平均(51.79±15.96)岁,以40岁以上年龄段为主,病期≥6个月患者占比最高72.22%。半数患者发病诱因与外伤有关,其中主要以鱼刺伤为主,多发皮损(22例,64.71%)高于单发皮损(12例,35.29%)。临床表现以斑块为主(15例,44.12%),主要位于手部(20例,58.82%)。核酸测序鉴定阳性率最高为85.29%,其次是抗酸染色70.59%,组织培养阳性率最低29.41%。菌种鉴定结果显示海分枝杆菌感染率最高21例(61.76%)。手术切除2例、中医治疗1例和抗生素治疗31例,28例临床治愈(82.35%),6例好转(17.65%),总有效率100%,复发4例(11.76%)。结论:皮肤NTM感染主要以海分枝杆菌感染为主,好发于中老年,皮损表现复杂多样,临床诊疗应综合考虑。
Objective:To explore the clinical characteristics,diagnosis and treatment methods of cutaneous NTM(nontuberculous mycobacteria)infection,and to improve the understanding and diagnostic level of cutaneous NTM infection.Methods:From April 2022 to August 2024,57 patients with suspected cutaneous NTM infection were collected from the Dermatology Outpatient Department of Xijing Hospital.The results of culture method,acid-fast staining,and nucleic acid sequencing,as well as the treatment and prognosis,were statistically analyzed.Results:Thirty four cases were finally diagnosed with cutaneous NTM infection,including 18 males(52.94%)and 16 females(47.06%).The onset age ranged from 14 to 81 years old,with an average age of(51.79±15.96)years old,mainly in the age group over 40 years old.Patients with disease duration≥6 months accounted for the highest proportion(72.22%).Half of the patients had trauma-related onset causes,mainly fishbone stabbing.There were 22 cases(64.71%)of multiple skin lesions,which was higher than 12 cases(35.29%)of single skin lesions.The main clinical manifestation was plaques,accounting for 44.12%;the main affected site was the hand,accounting for 58.82%.The positivity rate of nucleic acid sequencing identification was the highest,which was 85.29%,followed by acid-fast staining of 70.59%,and that of tissue culture was the lowest,which was 29.41%.In terms of species identification results,the infection rate of Mycobacterium marinum was the highest,with 21 cases(61.76%).There was 2 case treated by surgical resection,1 case with traditional Chinese medicine treatment and 31 cases treated with antibiotics.28 cases(82.35%)were clinically cured,6 cases(17.65%)improved,the total effective rate was 100%,and 4 cases(11.76%)relapsed.Conclusion:Cutaneous NTM infection is mainly caused by Mycobacterium marinum infection,which is more common in middle-aged and elderly people.The manifestations of skin lesions are complex and diverse,and comprehensive consideration should be given in clinical diagnosis and treatment.
作者
曾成龙
付萌
王胜春
冯婷
梁媛媛
王洪生
张文月
陶晓莉
ZENG Chenglong;FU Meng;WANG Shengchun;FENG Ting;LIANG Yuanyuan;WANG Hongsheng;ZHANG Wenyue;TAO Xiaoli(Department of Dermatology,Xijing Hospital,Fourth Military Medical University,Xi'an 710032,China;Mycobacterium Laboratory,Institute of Dermatology,Chinese Academy of Medical Sciences,Nanjing 210042,China;Department of Pathogenic Biology,School of Basic Medicine,Jinzhou Medical University,Jinzhou 121000,China)
出处
《中国麻风皮肤病杂志》
2025年第11期775-779,共5页
China Journal of Leprosy and Skin Diseases
基金
2024年医务人员培养助推立项资助项目(编号:XJZT24JC26)。
关键词
非结核分枝杆菌
抗酸染色
核酸测序
nontuberculous mycobacteria
acid-fast staining
nucleic acid sequencing
