Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
Sci Rep. 2016 Jul 11;6:29443. doi: 10.1038/srep29443.
Increasing evidence indicates that the risk of nontuberculous mycobacteria (NTM) disease is elevated in patients with rheumatoid arthritis (RA). However, the risk factors and outcomes for NTM disease among RA patients remain unclear. We conducted a case-control study and estimated odds ratios (ORs) for RA patients with NTM disease according to comorbidities and anti-rheumatic medications by using conditional logistic regression. Prior tuberculosis history (adjusted OR (aOR) =5.58, p < 0.001), hypertension (aOR = 2.55, p = 0.013), diabetes mellitus (aOR = 3.31, p = 0.005), interstitial lung disease (aOR = 8.22, p < 0.001), chronic obstructive pulmonary disease (aOR = 8.59, p < 0.001) and exposure to oral corticosteroids in a dose-dependent manner (5- < 10 mg/day aOR = 2.51, Ptrend = 0.007) were associated with a significantly increased risk of NTM disease in RA patients. The predominant species causing NTM disease in RA patients was Mycobacterium intracellulare (46.0%). Most NTM isolates were resistant to the majority of the antibiotics that are currently available, which maybe caused treatment failure; hospitalization and mortality are increased. To prevent and treat NTM disease efficiently, we suggested that it is important to monitor the development of NTM disease in RA patients receiving therapy with corticosteroids, particularly in those with predisposing factors.
越来越多的证据表明，类风湿关节炎（RA）患者患非结核分枝杆菌（NTM）病的风险增加。然而，RA 患者患 NTM 病的风险因素和结局仍不清楚。我们进行了一项病例对照研究，并通过条件逻辑回归，根据合并症和抗风湿药物，估计了患有 NTM 病的 RA 患者的比值比（OR）。既往结核病史（校正 OR（aOR）=5.58，p<0.001）、高血压（aOR=2.55，p=0.013）、糖尿病（aOR=3.31，p=0.005）、间质性肺病（aOR=8.22，p<0.001）、慢性阻塞性肺疾病（aOR=8.59，p<0.001）以及口服皮质类固醇暴露呈剂量依赖性增加（5-<10 mg/天 aOR=2.51，Ptrend=0.007）与 RA 患者患 NTM 病的风险显著增加相关。引起 RA 患者 NTM 病的主要菌种是细胞内分枝杆菌（Mycobacterium intracellulare）（46.0%）。大多数 NTM 分离株对目前可获得的大多数抗生素具有耐药性，这可能导致治疗失败；住院和死亡率增加。为了有效预防和治疗 NTM 病，我们建议重要的是要监测接受皮质类固醇治疗的 RA 患者中 NTM 病的发展情况，特别是在有易患因素的患者中。
