2018-08-012024-05-16https://scholars.lib.ntu.edu.tw/handle/123456789/668366摘要：非結核分枝桿菌是全球重要的新興感染症，在台灣的流行病學研究發現，非結核分枝桿菌的發生率持續上升，其中又以鳥型分枝桿菌群(Mycobacterium avium complex, MAC)是最常造成肺部感染之非結核分枝桿菌。鳥型分枝桿菌群屬於緩慢生長非結核性分枝桿菌，很容易具有多重抗藥性，治療上相當棘手。鳥型分枝桿菌群中包含數種菌種，但傳統生化鑑定法並無法針對菌種加以區分。過去認為最常造成肺部感染的菌種為M. avium 以及M. intracellulare，然而，最近運用分子生物鑑定技術的研究發現，在鳥型分枝桿菌群肺部感染中，約有30%是由鳥型分枝桿菌群中的其他菌種，如：M. chimaera，所引起。進行非結核分枝桿菌的菌種鑑定對於臨床治療以及預後會有很大的幫助，例如在膿腫分枝桿菌中，特定的亞種有著不同的藥物敏感性測試結果，同時也有著不同的治療預後。因此，精確鑑別造成之肺部鳥型分枝桿菌群感染之特異菌種發生率，了解不同菌種之抗藥特性，臨床表現、預後及治療的反應如何，將十分有助於臨床之治療決策。然而，目前對於台灣鳥型分枝桿菌群的肺部感染，不同菌種的發生率，不同菌種的藥物敏感性測試結果及預後依然缺乏詳細了解。本研究希望於藉由台大醫院過去(2013-2015年)所分離的200株鳥型分枝桿菌群菌株進行研究。運用三種基因定序法，精確鑑定造成感染之菌種，探討不同菌種之發生率，了解各藥物抗藥性以及與病患治療結果相關性。我們亦將利用脈衝式膠體電泳(Pulsed-field gel electrophoresis)分析各菌株的分子相關性並與MALDI-TOF(matrix-assisted laser desorption ionization-time of flight)結果比較，建立相關性資料庫，以利後續快速分型並提供另一種多重抗藥菌株快速鑑定的參考。<br> Abstract: Nontuberculous mycobacterium (NTM) diseases are an emerging and important disease entity worldwide and the incidence of NTM diseases have been reported to paramount that of tuberculosis in Taiwan. Among all NTM species, Mycobacterium avium complex (MAC) ranks as the most prevalent pathogenic species which cause various human infections, especially pulmonary infections.Mycobacterium avium complex comprised M. avium, M. intracellulare, M. chimaera and other species but they are indistinguishable by standard physical and biochemical testing. Therefore, little is known about the differences in the clinical features, disease progression, responses to treatment and drugs resistances between pulmonary MAC infections cause by different species.We will use molecular species identification methods, including rpoB, HSP65 gene and discrepant analysis by ITS sequencing among pulmonary MAC infections diagnosis within 2013-2015 in NTUH. We will also compare the incidence, clinical features, disease prognoses and antimicrobial susceptibility testing (AST) among different species of pulmonary MAC infections. Genetic relatedness of the isolates is performed by using pulsed-field gel electrophoresis and the results will be compared with those of MALDI-TOF MS microbial typing. The results of AST, genotyping and clinical outcome would be clarified to seek potentially rapid diagnostic methods for identifying drug resistant or virulent strains from clinical isolates.鳥型分枝桿菌非結核分枝桿菌感染多重抗藥性抗藥性Nontuberculous mycobacterium (NTM)Mycobacterium aviumtuberculosis