吸入用阿米卡星治疗难治性非结核分枝杆菌肺病的疗效、安全性及可行性
The efficacy, safety, and feasibility of inhaled amikacin for the treatment of difficult-to-treat non-tuberculous mycobacterial lung diseases.
作者信息
Yagi Kazuma, Ishii Makoto, Namkoong Ho, Asami Takahiro, Iketani Osamu, Asakura Takanori, Suzuki Shoji, Sugiura Hiroaki, Yamada Yoshitake, Nishimura Tomoyasu, Fujiwara Hiroshi, Funatsu Yohei, Uwamino Yoshifumi, Kamo Tetsuro, Tasaka Sadatomo, Betsuyaku Tomoko, Hasegawa Naoki
机构信息
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Pharmacy, Keio University Hospital, Shinjuku-ku, Tokyo, Japan.
出版信息
BMC Infect Dis. 2017 Aug 9;17(1):558. doi: 10.1186/s12879-017-2665-5.
BACKGROUND
In multidrug regimens, including an intravenous aminoglycoside (e.g. amikacin [AMK]) is recommended for difficult-to-treat non-tuberculous mycobacterial (NTM) lung diseases. We aimed to evaluate the efficacy, safety, and feasibility of inhaled AMK therapy in patients with difficult-to-treat NTM lung diseases in a retrospective chart review.
METHODS
The study population consisted of patients with NTM lung diseases who received combination therapy, including inhaled AMK therapy, at Keio University Hospital (Tokyo, Japan), from January 2014 through May 2016. A total of 26 cases, consisting of 23 Mycobacterium avium complex (MAC) and three Mycobacterium abscessus complex (MABC) infections cases, were included in this study. The efficacy, safety, and feasibility of inhaled AMK therapy were retrospectively investigated. The Research Ethics Committee of Keio University Hospital approved this study, and informed consent was obtained from all patients.
RESULTS
All 26 patients were culture-positive at enrolment. Twenty-three of the 26 patients (88.5%), including 21/23 MAC patients (91.3%) and 2/3 MABC patients (66.7%), were administered inhaled AMK therapy for >3 months. The proportion of patients who had clinical symptoms, including, cough and sputum, declined after inhalation AMK therapy. Ten of the 23 patients (43.5%) who received AMK inhalation, including 8/21 MAC (38.1%) and 2/2 MABC patients (100%), showed sputum conversion, defined as at least three consecutive negative sputum cultures. Seven of the 23 patients, including, 5/21 MAC and 2/2 MABC patients, showed improvements in high-resolution computed tomography imaging of the chest. In addition, the serum AMK trough levels before the second inhalation were <1.2 μg/mL in all 26 patients, with no occurrence of severe adverse events, such as renal toxicity. One patient (3.8%) experienced auditory toxicity, in the form of tinnitus. However, this symptom was reversible, after temporary interruption of AMK, the patient was able to safely resume the therapy.
CONCLUSIONS
Inhaled AMK therapy is an effective and feasible therapy for difficult-to-treat NTM lung disease.
背景
在多药联合治疗方案中，对于难治性非结核分枝杆菌（NTM）肺病，推荐使用静脉注射氨基糖苷类药物（如阿米卡星[AMK]）。我们旨在通过回顾性病历审查，评估吸入性AMK疗法对难治性NTM肺病患者的疗效、安全性和可行性。
方法
研究人群包括2014年1月至2016年5月在日本东京庆应义塾大学医院接受包括吸入性AMK疗法在内的联合治疗的NTM肺病患者。本研究共纳入26例病例，其中包括23例鸟分枝杆菌复合群（MAC）感染病例和3例脓肿分枝杆菌复合群（MABC）感染病例。对吸入性AMK疗法的疗效、安全性和可行性进行回顾性研究。庆应义塾大学医院研究伦理委员会批准了本研究，并获得了所有患者的知情同意。
结果
所有26例患者在入组时培养均为阳性。26例患者中有23例（88.5%），包括21/23例MAC患者（91.3%）和2/3例MABC患者（66.7%）接受了超过3个月的吸入性AMK治疗。吸入AMK治疗后，有咳嗽和咳痰等临床症状的患者比例下降。接受AMK吸入治疗的23例患者中有10例（43.5%），包括8/21例MAC患者（38.1%）和2/2例MABC患者（100%）痰菌转阴，定义为连续至少3次痰培养阴性。23例患者中有7例，包括5/21例MAC患者和2/2例MABC患者，胸部高分辨率计算机断层扫描成像显示有所改善。此外，所有26例患者在第二次吸入前血清AMK谷浓度均<1.2μg/mL，未发生肾毒性等严重不良事件。1例患者（3.8%）出现耳鸣形式的听觉毒性。然而，该症状是可逆的，在暂时中断AMK治疗后，患者能够安全地恢复治疗。
结论
吸入性AMK疗法是治疗难治性NTM肺病的一种有效且可行的疗法。
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