利用晶片檢驗分析台灣中部地區分枝桿菌之菌種分離率

Analyze Isolation Rate of Mycobacteria Isolated from Central Taiwan Area by Microarray

結核病為全世界死亡率最高的傳染性疾病，是由結核分枝桿菌群(Mycobacterium tuberculosiscomplex，MTBC)感染所引起，並為最常造成人類發病的分枝桿菌菌種。在臺灣目前仍然是高死亡率的傳染病，由於結核病防堵政策的奏效其發生率已逐年下降，但非結核分枝桿菌(Non-Tuberculous Mycobacteria，NTM)感染的案例卻持續被報告。本研究分析2012年1月至2013年12月間臨床所分離的2336株分枝桿菌，利用生物晶片DR.TBDR/NTM IVD kit進行鑑定。結果發現MTBC分離率佔比為38.14%(891/2336)，而NTM分離率佔比為61.86%(1445/2336)，其中快速生長型NTM分離最多的菌種為M. abscessus 15.54%(363/2336)，其次為M. fortuitum 5.01%(117/2336)及M. chelonae 1.28%(30/2336)；慢速生長型NTM最常分離的菌種包括Mycobacterium avium complex(M. intracellulare and M. avium) 20.51%(479/2336)、M. gordonae 5.09%(119/2336)及M. kansasii4.11%(96/2336)。另外培養陽性抹片陽性率為28.74%(641/2230)，641筆培養及抹片皆為陽性的結果中，MTBC佔比為64.12%(411/641)，NTM佔比為35.88%(230/641)。陽性菌株的培養時間，MTBC平均為24.31天，NTM平均為15.73天。實驗結果得知在台灣中部地區NTM之分離率已大幅超越MTBC，然而NTM所引起的肺部感染疾病很難與結核病區分，因此增進實驗室鑑別分枝桿菌的能力進而幫助臨床醫師診斷及進行適當的治療是很重要的事情。

Tuberculosis(TB) remains one of the world's deadliest communicable disease. It is generally caused by infection Mycobacterium tuberculosis complex(MTBC), which is the most common cause of mycobacteria disease. The mortality is still unacceptably high in Taiwan now. TB incidence declines each year through effective tuberculosis control policy in Taiwan but Non-Tuberculous Mycobacteria( NTM) infection is continuously reported. The present study applied a locally manufactured biochip Dr.TBDR/NTM IVD kit (DR. Chip Biotech Inc.) to identify 2336 isolates of mycobacteria isolated from Chung Shan Medical University-Hospital (Taichung, Taiwan) from January of 2012 to December of 2013. Result indicated that the isolation rate for MTBC was 38.14%, while the rate for NTM was 61.86%. Among rapidly growing NTM, the highest isolation rate was for M. abscessus (15.54%), with the M. fortuitum (5.01%) and M. chelonae (1.28%) coming next. For slowly growing NTM, the most common isolation was Mycobacterium avium complex (M. intracellulare and M. avium) (20.51%), followed by M. gordonae (5.09%) and M. kansasii (4.11%). The overall AFB smears positive rate was 28.74%. The proportions of positive smears, MTBC and NTM was 64.12% and 35.88%, respectively. The average of culture time for MTBC was 24.31 days and for NTM was 15.73 days. The result showed NTM isolation rate was over than MTBC. However, it is difficult to distinguish the pulmonary NTM infection from tuberculosis. Hence, it is important to enhance the accuracy of diagnose mycobacteria disease to provide appropriate therapy.