Hagiwara Eri, Katano Takuma, Isomoto Kohsuke, Otoshi Ryota, Yamakawa Hideaki, Okuda Ryo, Sekine Akimasa, Baba Tomohisa, Komatsu Shigeru, Ogura Takashi
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan.
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan.
Respir Investig. 2019 Jan;57(1):54-59. doi: 10.1016/j.resinv.2018.08.006. Epub 2018 Oct 24.
The incidence of asymptomatic pulmonary Mycobacterium avium complex (MAC) disease appears to be increasing. This study aimed to determine the clinical characteristics and examine early outcomes of patients newly diagnosed with MAC disease.
We retrospectively reviewed the medical records of all 184 patients newly diagnosed with MAC disease between April 2013 and March 2015 at our hospital. Culture conversion, defined as at least two consecutive negative cultures, was used as the early outcome measure.
Of 184 patients, 45 were male and 139 were female, with a mean age of 70 years. Abnormal chest shadow found during an annual health check-up (58 patients) or incidentally during visits for other diseases (72 patients), was the major reason for referral to hospital, typically with no symptoms. Anti-MAC IgA antibody was positive in 64.5% of patients, and the positive rate was associated with the extent of lesions. Clarithromycin-based multi-drug chemotherapy was initiated in 111 patients. Culture conversion was achieved in 61 of 82 (74.4%) patients who were able to continue multi-drug chemotherapy. Patients who achieved culture conversion were more likely to be younger, female, and have a lower smear grade and nodular-bronchiectatic type. Multivariate logistic regression analysis identified patient age and smear grade as predictive variables.
Abnormal chest shadow found during health check-up was the major reason for hospital visits, and most were asymptomatic. Culture conversion was achieved in three-fourths of patients treated, and was associated with age and smear grade, supporting early intervention at a younger age.
无症状鸟分枝杆菌复合体（MAC）肺病的发病率似乎在上升。本研究旨在确定新诊断为MAC病患者的临床特征并检查其早期结局。
我们回顾性分析了2013年4月至2015年3月期间在我院新诊断为MAC病的184例患者的病历。以连续至少两次培养阴性定义的培养转阴作为早期结局指标。
184例患者中，男性45例，女性139例，平均年龄70岁。年度健康检查时发现的胸部阴影异常（58例患者）或因其他疾病就诊时偶然发现（72例患者）是转诊至医院的主要原因，通常无症状。64.5%的患者抗MAC IgA抗体呈阳性，阳性率与病变范围相关。111例患者开始使用以克拉霉素为基础的多药化疗。在能够继续多药化疗的82例患者中，61例（74.4%）实现了培养转阴。实现培养转阴的患者更可能年龄较小、为女性、涂片分级较低且为结节支气管扩张型。多因素逻辑回归分析确定患者年龄和涂片分级为预测变量。
健康检查时发现的胸部阴影异常是就诊的主要原因，大多数患者无症状。四分之三接受治疗的患者实现了培养转阴，且与年龄和涂片分级相关，支持在较年轻时进行早期干预。
