Kotilainen H, Valtonen V, Tukiainen P, Poussa T, Eskola J, Järvinen A
University of Helsinki and Division of Infectious Diseases, Inflammation Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland,
Eur J Clin Microbiol Infect Dis. 2015 Sep;34(9):1909-18. doi: 10.1007/s10096-015-2432-8. Epub 2015 Jul 9.
We compared the clinical findings and survival in patients with Mycobacterium avium complex (MAC) and other non-tuberculous mycobacteria (NTM). A total of 167 adult non-human immunodeficiency virus (HIV) patients with at least one positive culture for NTM were included. Medical records were reviewed. The patients were categorised according to the 2007 American Thoracic Society (ATS) criteria. MAC comprised 59 % of all NTM findings. MAC patients were more often female (70 % vs. 34 %, p < 0.001) and had less fatal underlying diseases (23 % vs. 47 %, p = 0.001) as compared to other NTM patients. Symptoms compatible with NTM infection had lasted for less than a year in 34 % of MAC patients but in 54 % of other NTM patients (p = 0.037). Pulmonary MAC patients had a significantly lower risk of death compared to pulmonary other NTM (hazard ratio [HR] 0.50, 95 % confidence interval [CI] 0.33-0.77, p = 0.002) or subgroup of other slowly growing NTM (HR 0.55, 95 % CI 0.31-0.99, p = 0.048) or as rapidly growing NTM (HR 0.47, 95 % CI 0.25-0.87, p = 0.02). The median survival time was 13.0 years (95 % CI 5.9-20.1) for pulmonary MAC but 4.6 years (95 % CI 3.4-5.9) for pulmonary other NTM. Serious underlying diseases (HR 3.21, 95 % CI 2.05-5.01, p < 0.001) and age (HR 1.07, 95 % CI 1.04-1.09, p < 0.001) were the significant predictors of mortality and female sex was a predictor of survival (HR 0.38, 95 % CI 0.24-0.59, p < 0.001) in the multivariate analysis. Pulmonary MAC patients had better prognosis than pulmonary other NTM patients. The symptom onset suggests a fairly rapid disease course.
我们比较了鸟分枝杆菌复合体（MAC）患者与其他非结核分枝杆菌（NTM）患者的临床发现和生存率。总共纳入了167例成年非人类免疫缺陷病毒（HIV）患者，这些患者至少有一次NTM培养呈阳性。对病历进行了回顾。根据2007年美国胸科学会（ATS）标准对患者进行分类。MAC占所有NTM发现的59%。与其他NTM患者相比，MAC患者女性更常见（70%对34%，p<0.001），致命性基础疾病更少（23%对47%，p=0.001）。34%的MAC患者与NTM感染相符的症状持续时间不到一年，而其他NTM患者中这一比例为54%（p=0.037）。与肺部其他NTM患者相比，肺部MAC患者的死亡风险显著更低（风险比[HR]0.50，95%置信区间[CI]0.33 - 0.77，p=0.002），或与其他缓慢生长的NTM亚组相比（HR 0.55，95%CI 0.31 - 0.99，p=0.048），或与快速生长的NTM相比（HR 0.47，95%CI 0.25 - 0.87，p=0.02）。肺部MAC患者的中位生存时间为13.0年（95%CI 5.9 - 20.1），而肺部其他NTM患者为4.6年（95%CI 3.4 - 5.9）。在多变量分析中，严重基础疾病（HR 3.21，95%CI 2.05 - 5.01，p<0.001）和年龄（HR 1.07，95%CI 1.04 - 1.09，p<0.001）是死亡率的显著预测因素，女性性别是生存的预测因素（HR 0.38，95%CI 0.24 - 0.59，p<0.001）。肺部MAC患者的预后比肺部其他NTM患者更好。症状发作提示疾病进程相当迅速。
