中国麻风皮肤病杂志 ›› 2022, Vol. 38 ›› Issue (11): 785-789.doi: 10.12144/zgmfskin202211785

• 论著 • 上一篇    下一篇

29例皮肤非结核分枝杆菌感染临床分析

王欢,王春又,梁高澎,张恋,邓思思,张静,邓向芬,翟志芳   

  1. 陆军军医大学第一附属医院，重庆，400038
  • 出版日期:2022-11-15 发布日期:2022-10-25

Clinical characteristics of 29 cases with cutaneous nontuberculous mycobacteria infection

WANG Huan, WANG Chunyou, LIANG Gaopeng, ZHANG Lian, DENG Sisi, ZHANG Jing, DENG Xiangfen, ZHAI Zhifang   

  1. Department of Dermatology, The First Affiliated Hospital of Army Military Medical University, Chongqing 400038, China
  • Online:2022-11-15 Published:2022-10-25

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摘要： 目的：分析皮肤非结核分枝杆菌感染的临床特点, 探讨常见诱因、临床特点及其诊断方法。方法：分析29例患者临床特征，比较不同检测方法在NTM感染诊断中的价值。结果：29例患者中，外伤诱发者8例，美容、注射诱发者6例。皮损主要以结节为主（19例），其中伴溃疡者7例；病变单发者18例，多发者11例，以四肢的创伤部位为主。病理以肉芽肿性炎症为主（17例）。mNGS阳性率（4/4，100%），PCR-RDB（13/15，86.7%），C-基因芯片杂交法1例阳性（1/5，20%），组织培养阳性率最低（1/12，8%）。临床采用抗生素治疗，15例临床治愈（51.7%），4例好转（13.8%），3例无效（1例死亡），7例失访。结论：皮肤NTM感染中外伤或美容手术、注射为近年来不可忽视的诱因，组织病理改变无致病菌特异性。聚合酶链反应-反向斑点杂交法及宏基因组学检测有助于尽早明确NTM的病原学依据，早期诊断及治疗。

关键词: 非结核分枝杆菌, 临床表现, 组织病理学, 聚合酶链反应, 基因检测

Abstract: Objective: To analyze the clinical features of cutaneous non-tuberculous mycobacterium (NTM) infection, to investigate the common causes, clinical features and diagnostic methods. Methods: To analyze the clinical features of 29 patients and compare the value of different methods in the diagnosis of NTM infection. Results: Of 29 patients, 8 were induced by trauma, and 6 were induced by cosmetic and injection. Nodules were the main lesions (19 cases) and 7 cases were accompanied with ulcers. There were 18 cases of single lesions and 11 cases of multiple lesions, mainly in the extremities. The histological features were mainly granulomatous inflammation (17 cases). The positivity rate of mNGS was the highest (4/4, 100%), followed by polymerase chain reaction-reverse dot blot (PCR-RDB) (13/15, 86.7%) and C-gene chip (1/5, 20%),and tissue culture was the lowest (1/12, 8%). Antibiotics were used, fifteen cases (51.7%) were cured, 4 cases (13.8%) were improved, 3 cases were ineffective, 7 cases were lost to follow-up. Conclusion: Cutaneous NTM caused by trauma, cosmetic surgery and injection can not be ignored in recent years. The histopathological changes are not specific for pathogenic bacteria. Polymerase chain react-reverse dot blot hybridization and metagenomics detection are helpful to identify the etiological of NTM.

Key words: Non-tuberculous mycobacterium, clinical manifestations, histopathology, polymerase chain reaction, genetic detection