Yeung Man Wah, Khoo Edwin, Brode Sarah K, Jamieson Frances B, Kamiya Hiroyuki, Kwong Jeffrey C, Macdonald Liane, Marras Theodore K, Morimoto Kozo, Sander Beate
Public Health Ontario, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Respirology. 2016 Aug;21(6):1015-25. doi: 10.1111/resp.12767. Epub 2016 Mar 23.
Nontuberculous mycobacterial (NTM) infections are increasing in disease frequency worldwide. This systematic review examines health-related quality of life (HRQOL), comorbidities and mortality associated with pulmonary NTM disease. We searched MEDLINE, EMBASE, CINAHL, Scopus Life Sciences, conference proceedings and Google (earliest date available to February 2015) for primary studies. Eligible studies compared populations with and without pulmonary NTM disease in high-income jurisdictions. We excluded studies on HIV/AIDS. All languages were accepted. Two reviewers followed MOOSE and PRISMA reporting guidelines and independently appraised quality using STROBE. All studies were summarized qualitatively regardless of quality. Of 3193 citations screened, we included 17 studies mostly from Taiwan (n = 5) and the USA (n = 4). Two studies assessed HRQOL; one assessed comorbidities, 11 assessed mortality, and three assessed multiple outcomes. Populations with pulmonary NTM reported significantly worse or similar HRQOL than the general population, depending on the instruments used. Some suggested greater prevalence of having bronchiectasis (n = 2) and greater risk of developing pulmonary tuberculosis (n = 1). Most (n = 7) suggested no difference in mortality, although only one was age-matched and gender-matched to the general population. Four suggested NTM populations had higher mortality-two of which compared with the general population and were deemed of high quality, while two compared with non-NTM patients from hospital. High clinical heterogeneity in study design may explain discordant results. Bias assessments and controlling for confounding were carried out poorly. No consistent trends were observed although there is suggestion of an increased health burden from respiratory diseases and increased mortality associated with pulmonary NTM disease.
非结核分枝杆菌（NTM）感染在全球范围内的疾病发生率正在上升。本系统评价考察了与肺部NTM疾病相关的健康相关生活质量（HRQOL）、合并症和死亡率。我们检索了MEDLINE、EMBASE、CINAHL、Scopus生命科学数据库、会议论文集以及谷歌（最早时间至2015年2月），以查找原始研究。符合条件的研究比较了高收入地区有和没有肺部NTM疾病的人群。我们排除了关于艾滋病毒/艾滋病的研究。接受所有语言的文献。两名评审员遵循MOOSE和PRISMA报告指南，并使用STROBE独立评估质量。无论质量如何，所有研究均进行定性总结。在筛选的3193篇文献中，我们纳入了17项研究，其中大部分来自台湾（n = 5）和美国（n = 4）。两项研究评估了HRQOL；一项评估了合并症，11项评估了死亡率，三项评估了多种结局。根据所使用的工具，肺部NTM患者报告的HRQOL显著差于或与一般人群相似。一些研究表明支气管扩张的患病率更高（n = 2），患肺结核的风险更大（n = 1）。大多数研究（n = 7）表明死亡率无差异，尽管只有一项研究在年龄和性别上与一般人群匹配。四项研究表明NTM患者的死亡率更高，其中两项与一般人群相比，被认为质量较高，而另外两项与医院的非NTM患者相比。研究设计中的高度临床异质性可能解释了不一致的结果。偏倚评估和混杂因素控制做得很差。尽管有迹象表明肺部NTM疾病会增加呼吸系统疾病的健康负担和死亡率，但未观察到一致的趋势。
