Yeh Jun-Jun, Wang Yu-Chiao, Sung Fung-Chang, Chou Christine Yi-Ting, Kao Chia-Hung
Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan.
Lung. 2014 Jun;192(3):403-11. doi: 10.1007/s00408-014-9574-9. Epub 2014 Apr 2.
The aim of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and nontuberculosis mycobacterium (NTM) disease.
We used data from the National Health Insurance Research Database of Taiwan in this study. The NTM cohort contained 3,005 patients, and each case was randomly frequency matched by age, sex, income, occupation, and index year with four people from the general population without NTM infections. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) of COPD in the NTM cohort compared with the non-NTM cohort.
The incidence of COPD was 3.08-fold higher (21.75 vs. 6.11 per 1,000 person-years) in the NTM cohort than in the non-NTM cohort. The aHR of COPD comparing the NTM cohort with the non-NTM cohort was 3.57 (95 % CI 2.56-4.97) for women and 2.89 (95 % CI 2.31-3.61) for men. The aHR of COPD was higher in the patients with NTM infection and a comorbidity such as bronchopneumonia, pneumonia, diabetes, asthma, and heart disease. The Mycobacterium avium-intracellulare complex group (MAC) and the non-MAC group were isolated in the NTM cohort. The MAC group had a higher aHR of COPD than the non-NTM cohort (aHR = 3.72, 95 % CI 2.94-4.72). The cumulative incidence of COPD in the NTM cohort was higher than in the non-NTM cohort (P < 0.0001, log rank test).
Physicians should be aware of indolent NTM disease that increases the risk of COPD.
本研究旨在评估慢性阻塞性肺疾病（COPD）与非结核分枝杆菌（NTM）疾病之间的关联。
在本研究中，我们使用了台湾国民健康保险研究数据库的数据。NTM队列包含3005名患者，每个病例按年龄、性别、收入、职业和索引年份与4名未感染NTM的普通人群进行随机频率匹配。使用多变量Cox比例风险回归计算NTM队列中COPD与非NTM队列相比的调整后风险比（aHR）。
NTM队列中COPD的发病率比非NTM队列高3.08倍（每1000人年分别为21.75和6.11）。NTM队列与非NTM队列相比，女性COPD的aHR为3.57（95%CI 2.56 - 4.97），男性为2.89（95%CI 2.31 - 3.61）。NTM感染且合并支气管肺炎、肺炎、糖尿病、哮喘和心脏病等疾病的患者中COPD的aHR更高。在NTM队列中分离出鸟分枝杆菌复合群（MAC）组和非MAC组。MAC组COPD的aHR高于非NTM队列（aHR = 3.72，95%CI 2.94 - 4.72）。NTM队列中COPD的累积发病率高于非NTM队列（P < 0.0001，对数秩检验）。
医生应意识到隐匿性NTM疾病会增加COPD的风险。
