Dept of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
These authors contributed equally to this work.
Eur Respir J. 2017 Mar 8;49(3). doi: 10.1183/13993003.00537-2016. Print 2017 Mar.
Little is known about the long-term natural history of complex lung disease (MAC-LD) in untreated patients with stable course.The aim of this study was to investigate the natural course of untreated stable MAC-LD, with a focus on factors associated with clinical deterioration, spontaneous sputum conversion and prognosis.Of 488 patients diagnosed with MAC-LD between 1998 and 2011, 305 patients (62.5%) showed progressive MAC-LD resulting in treatment initiation within 3 years of diagnosis and 115 patients (23.6%) exhibited stable MAC-LD for at least 3 years with a median follow-up duration of 5.6 years. Patients with stable MAC-LD were more likely to have higher body mass index and less systemic symptoms at initial diagnosis compared with patients with progressive MAC-LD, while positive sputum acid-fast bacilli smear, fibrocavitary type and more extensive disease in radiological findings were more associated with progressive MAC-LD. Of the untreated patients with stable MAC-LD, 51.6% underwent spontaneous sputum conversion, with younger age, higher body mass index and negative sputum acid-fast bacilli smear at initial diagnosis found to be predictors of this occurrence.Advanced age, fibrocavitary type and abnormal pulmonary function were negative prognostic factors for survival in patients with stable MAC-LD.
对于未经治疗且病情稳定的复杂肺部疾病（MAC-LD）患者，其长期自然病史知之甚少。本研究旨在探讨未经治疗的稳定 MAC-LD 的自然病程，重点关注与临床恶化、自发痰转化和预后相关的因素。在 1998 年至 2011 年间诊断为 MAC-LD 的 488 例患者中，305 例（62.5%）出现进行性 MAC-LD，导致在诊断后 3 年内开始治疗，115 例（23.6%）至少稳定 MAC-LD 3 年，中位随访时间为 5.6 年。与进行性 MAC-LD 患者相比，稳定 MAC-LD 患者在初始诊断时更可能具有更高的体重指数和较少的全身症状，而阳性痰抗酸杆菌涂片、纤维空洞型和影像学检查中更广泛的病变与进行性 MAC-LD 更相关。在未经治疗的稳定 MAC-LD 患者中，51.6%自发痰转化，初始诊断时年龄较小、体重指数较高和痰抗酸杆菌涂片阴性是自发痰转化的预测因素。高龄、纤维空洞型和肺功能异常是稳定 MAC-LD 患者生存的负性预后因素。
