分枝杆菌脓肿群肺部感染治疗后生活质量的改善。一项前瞻性队列研究。
Improvement in Quality of Life after Therapy for Mycobacterium abscessus Group Lung Infection. A Prospective Cohort Study.
机构信息
1 Department of Medicine, National Jewish Health, Denver, Colorado.
2 Department of Family Medicine.
出版信息
Ann Am Thorac Soc. 2016 Jan;13(1):40-8. doi: 10.1513/AnnalsATS.201508-529OC.
RATIONALE
Mycobacterium abscessus group lung infection is characterized by low cure rates. Improvement in quality of life may be a reasonable treatment goal.
OBJECTIVES
The objective of this study was to evaluate change in quality of life in response to therapy, predictors of improvement in quality of life, and association of quality of life with traditional outcome measures.
METHODS
Forty-seven patients were treated for Mycobacterium abscessus group lung infection (including one with Mycobacterium chelonae) and were followed prospectively for 2 years between December 2009 and May 2012. St. George's Respiratory Questionnaire (SGRQ) was administered, chest computed tomography (CT) imaging was carried out, and culture data were collected at multiple time points. Predictors of improvement in the SGRQ total score greater than or equal to a minimal clinically important difference (MCID) at 12 months were evaluated.
MEASUREMENTS AND MAIN RESULTS
Patients were 85% female and 94% white, with a mean age of 65 years. Nine (20%) had a genetic diagnosis of cystic fibrosis (none F508del homozygous). Coinfection with Mycobacterium avium complex occurred in 28% and Pseudomonas in 26%. Chest CT imaging universally indicated bronchiectasis and nodules; 51% had lung cavities. Treatment included a mean of 17 months of antibiotics, and lung resection in 34%. Seventeen patients with M. avium complex (36%) and one with Mycobacterium kansasii were treated for coinfection. The mean SGRQ total score (SD) at baseline was 35 (20). At all follow-up time points, the mean SGRQ total score (SD) was significantly lower (better) than at baseline: 27 (17) at 3 months, P < 0.01; 27 (19) at 6 months, P < 0.01; 27 (20) at 12 months, P < 0.01; and 30 (22) at 24 months, P = 0.02. At 12 and 24 months, respectively, 60% and 56% had improvement greater than or equal to the MCID in SGRQ total score. Improvement greater than or equal to the MCID at 12 months was positively associated with a history of respiratory exacerbation, isolate susceptible to imipenem-cilastatin, and lung resection surgery, and negatively associated with nodules >4 mm in diameter on chest CT imaging, but these associations were not statistically significant in multivariable analysis. At 24 months, 16 patients (48%) with complete data were culture negative for 1 year and had discontinued M. abscessus group treatment.
CONCLUSIONS
Quality of life was a sensitive indicator of treatment response and has the potential to be a useful parameter to guide treatment.
背景
脓肿分枝杆菌群肺部感染的治愈率较低。提高生活质量可能是一个合理的治疗目标。
目的
本研究旨在评估治疗后生活质量的变化，预测生活质量改善的因素，以及生活质量与传统结局指标的相关性。
方法
2009 年 12 月至 2012 年 5 月期间，对 47 例脓肿分枝杆菌群肺部感染（包括 1 例分枝杆菌龟亚种感染）患者进行前瞻性随访 2 年。采用圣乔治呼吸问卷（SGRQ）进行评估，进行胸部计算机断层扫描（CT）成像，并在多个时间点采集培养数据。评估了 12 个月时 SGRQ 总分改善≥最小临床重要差异（MCID）的预测因素。
结果
患者均为女性（85%）和白人（94%），平均年龄为 65 岁。9 例（20%）存在囊性纤维化的基因诊断（均非 F508del 纯合子）。28%的患者合并鸟分枝杆菌复合体感染，26%的患者合并铜绿假单胞菌感染。胸部 CT 成像均显示支气管扩张和结节；51%的患者存在肺空洞。治疗包括平均 17 个月的抗生素治疗和 34%的肺切除术。17 例鸟分枝杆菌复合体（36%）和 1 例堪萨斯分枝杆菌感染患者接受了合并感染的治疗。基线时 SGRQ 总分（SD）的平均值为 35（20）。在所有随访时间点，SGRQ 总分（SD）均显著低于基线：3 个月时为 27（17），P<0.01；6 个月时为 27（19），P<0.01；12 个月时为 27（20），P<0.01；24 个月时为 30（22），P=0.02。分别在 12 个月和 24 个月时，60%和 56%的患者 SGRQ 总分改善≥MCID。12 个月时改善≥MCID 与呼吸恶化史、对亚胺培南-西司他丁敏感的分离株和肺切除术有关，与胸部 CT 成像上直径>4mm 的结节呈负相关，但在多变量分析中这些关联无统计学意义。24 个月时，16 例（48%）完成数据完整的患者连续 1 年培养阴性，已停止脓肿分枝杆菌群治疗。
结论
生活质量是治疗反应的敏感指标，有可能成为指导治疗的有用参数。
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