Ito Yutaka, Hirai Toyohiro, Fujita Kohei, Maekawa Koichi, Niimi Akio, Ichiyama Satoshi, Mishima Michiaki
Department of Respiratory Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Respiratory Medicine, Kyoto University, Kyoto, Japan.
J Infect Chemother. 2015 May;21(5):352-6. doi: 10.1016/j.jiac.2015.01.004. Epub 2015 Jan 9.
This study was conducted to evaluate trends in the isolation of strains of nontuberculous mycobacteria (NTM) and trends in the number of patients with pulmonary Mycobacterium avium complex (MAC) disease. We retrospectively reviewed microbiological results and clinical data to identify patients who were diagnosed with pulmonary MAC disease at Kyoto University Hospital in Japan between 2000 and 2013. NTM were isolated from 6327 of 80,285 samples (7.9%) for mycobacterial culture. The proportion of NTM isolates among all mycobacterial isolates increased from 355 of 792 samples (44.8%) in 2000 to 688 of 847 samples (81.2%) in 2013. MAC was most frequently observed (5436 isolates, 85.9%), followed by Mycobacterium abscessus (175 isolates, 2.8%) and Mycobacterium kansasii (74 isolates, 1.2%). A total of 592 patients with pulmonary MAC disease were identified (age, 66.0 ± 11.5 years; females, 61.1%). Compared with the early cohort (2000-2006, 236 patients), more patients in the late cohort (2007-2013, 356 patients) had an underlying disease (157 [66.5%] vs. 284 [79.8%], P = 0.0003), a Charlson comorbidity index score ≥ 1 (115 [48.7%] vs. 213 [59.8%], P = 0.008), collagen vascular disease (18 [7.6%] vs. 60 [16.9%], P = 0.001), rheumatoid arthritis (11 [4.7%] vs. 41 [11.5%], P = 0.004), and used immunosuppressive drugs (22 [9.3%] vs. 63 [17.7%], P = 0.004). The numbers of patients with lung disease, malignant disease and diabetes mellitus increased; however, their frequencies did not differ. The recovery rate of NTM and patients with pulmonary MAC disease increased, especially in patients with collagen vascular disease or rheumatoid arthritis or who used immunosuppressive drugs.
本研究旨在评估非结核分枝杆菌（NTM）菌株分离情况的趋势以及肺鸟分枝杆菌复合群（MAC）病患者数量的趋势。我们回顾性分析了微生物学结果和临床数据，以确定2000年至2013年期间在日本京都大学医院被诊断为肺MAC病的患者。在80285份用于分枝杆菌培养的样本中，有6327份（7.9%）分离出NTM。NTM分离株在所有分枝杆菌分离株中的比例从2000年792份样本中的355份（44.8%）增至2013年847份样本中的688份（81.2%）。最常观察到的是MAC（5436株分离株，85.9%），其次是脓肿分枝杆菌（175株分离株，2.8%）和堪萨斯分枝杆菌（74株分离株，1.2%）。共确定了592例肺MAC病患者（年龄66.0±11.5岁；女性占61.1%）。与早期队列（2000 - 2006年，236例患者）相比，晚期队列（2007 - 2013年，356例患者）中有更多患者患有基础疾病（157例[66.5%]对284例[79.8%]，P = 0.0003）、Charlson合并症指数评分≥1（115例[48.7%]对213例[59.8%]，P = 0.008）、胶原血管病（18例[7.6%]对60例[16.9%]，P = 0.001）、类风湿关节炎（11例[4.7%]对41例[11.5%]，P = 0.004），并且使用免疫抑制药物（22例[9.3%]对63例[17.7%]，P = 0.004）。患有肺病、恶性疾病和糖尿病的患者数量增加；然而，其发生率没有差异。NTM和肺MAC病患者的恢复率有所提高，尤其是在患有胶原血管病或类风湿关节炎或使用免疫抑制药物的患者中。
