Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Both authors contributed equally.
Eur Respir J. 2017 Sep 27;50(3). doi: 10.1183/13993003.02503-2016. Print 2017 Sep.
The effect of the clinical phenotype of complex (MAC) lung disease on treatment outcome and redevelopment of nontuberculous mycobacterial (NTM) lung disease after treatment completion has not been studied systematically.We evaluated 481 treatment-naïve patients with MAC lung disease who underwent antibiotic treatment for ≥12 months between January 2002 and December 2013.Out of 481 patients, 278 (58%) had noncavitary nodular bronchiectatic (NB) disease, 80 (17%) had cavitary NB disease and 123 (25%) had fibrocavitary disease. Favourable outcome was higher in patients with noncavitary disease (88%) than in patients with cavitary disease (76% for fibrocavitary and 78% for cavitary NB disease; p<0.05). Cavitary disease was independently associated with unfavourable outcomes (p<0.05). Out of 402 patients with favourable outcomes, 118 (29%) experienced redevelopment of NTM lung disease, with the same MAC species recurring in 65 (55%) patients. The NB form was an independent risk factor for redevelopment of NTM lung disease (p<0.05). In patients with recurrent MAC lung disease due to the same species, bacterial genotyping revealed that 74% of cases were attributable to reinfection and 26% to relapse.Treatment outcomes and redevelopment of NTM lung disease after treatment completion differed by clinical phenotype of MAC lung disease.
我们评估了 2002 年 1 月至 2013 年 12 月期间接受了至少 12 个月抗生素治疗的 481 例初治 MAC 肺病患者。481 例患者中，278 例（58%）为非空洞性结节性支气管扩张（NB）病变，80 例（17%）为空洞性 NB 病变，123 例（25%）为纤维空洞性病变。非空洞性疾病患者的治疗结局较好（88%），而空洞性疾病患者的治疗结局较差（纤维空洞性和空洞性 NB 疾病分别为 76%和 78%；p<0.05）。空洞性病变与不良结局独立相关（p<0.05）。402 例治疗结局良好的患者中，118 例（29%）发生 NTM 肺病再发，65 例（55%）患者的 MAC 物种相同。NB 形式是 NTM 肺病再发的独立危险因素（p<0.05）。在因相同物种而复发 MAC 肺病的患者中，细菌基因分型显示 74%的病例归因于再感染，26%归因于复发。MAC 肺病的临床表型不同，治疗结局和 NTM 肺病的再发也不同。
