低血清雌二醇水平与鸟分枝杆菌复合体肺病有关：一项横断面研究。
Low serum estradiol levels are related to Mycobacterium avium complex lung disease: a cross-sectional study.
机构信息
Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
出版信息
BMC Infect Dis. 2019 Dec 16;19(1):1055. doi: 10.1186/s12879-019-4668-x.
BACKGROUND
The risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known. We hypothesized that low serum estradiol (E2) levels are related to MAC-LD as most patients with MAC-LD are postmenopausal women.
METHODS
This cross-sectional study compared patients with MAC-LD and healthy controls. Study subjects were postmenopausal women aged 65 years or younger. Serum testosterone, dehydroepiandrosterone sulfate (DHEA-S), and E2 levels were measured and categorized as high or low based on median levels. We performed multivariate analysis, receiver operating characteristic (ROC) curve analysis, and age- and body mass index (BMI)-matched subgroup analysis to evaluate the association between low serum E2 levels and MAC-LD. Additionally, using blood samples obtained for other clinical studies, the levels of sex steroid hormones were compared between age- and BMI-matched MAC-LD and bronchiectasis female patients without non-tuberculosis mycobacterial infections (non-NTM BE).
RESULTS
Forty-two patients with MAC-LD and 91 healthy controls were included. The median E2 (2.20 pg/mL vs. 15.0 pg/mL, p < 0.001), testosterone (0.230 ng/L vs. 0.250 ng/L, p = 0.005), and DHEA-S (82.5 μg/dL vs. 114.0 μg/dL, p < 0.001) levels were lower in the MAC-LD group than in the control group. Multivariate analysis revealed that low serum E2 (adjusted odds ratio = 34.62, 95% confidence interval = 6.02-199.14) was independently related to MAC-LD, whereas low DHEA-S and testosterone were not. ROC analysis illustrated a strong relationship between low serum E2 levels and MAC-LD (area under the curve = 0.947, 95% confidence interval = 0.899-0.995). Even the age- and BMI-matched subgroup analysis of 17 MAC-LD patients and 17 healthy controls showed lower serum E2 in MAC-LD patients than in healthy controls. Additionally, serum E2 levels of 20 MAC-LD patients were lower than plasma E2 levels of 11 matched non-NTM BE patients (1.79 pg/mL vs. 11.0 pg/mL, p < 0.001).
CONCLUSIONS
Low serum E2 levels were strongly related to MAC-LD in postmenopausal women.
背景
禽分枝杆菌复合体肺病（MAC-LD）的风险因素尚不清楚。我们假设低血清雌二醇（E2）水平与 MAC-LD 有关，因为大多数 MAC-LD 患者为绝经后女性。
方法
本横断面研究比较了 MAC-LD 患者和健康对照组。研究对象为年龄在 65 岁及以下的绝经后女性。根据中位数水平，将血清睾酮、脱氢表雄酮硫酸酯（DHEA-S）和 E2 水平分为高或低。我们进行了多变量分析、受试者工作特征（ROC）曲线分析和年龄及体重指数（BMI）匹配的亚组分析，以评估低血清 E2 水平与 MAC-LD 之间的关系。此外，使用其他临床研究获得的血液样本，比较了年龄和 BMI 匹配的 MAC-LD 和无非结核分枝杆菌感染的支气管扩张女性患者（非-NTM BE）的性激素水平。
结果
纳入了 42 例 MAC-LD 患者和 91 名健康对照组。MAC-LD 组的中位 E2（2.20pg/mL 比 15.0pg/mL，p<0.001）、睾酮（0.230ng/L 比 0.250ng/L，p=0.005）和 DHEA-S（82.5μg/dL 比 114.0μg/dL，p<0.001）水平均低于对照组。多变量分析显示，低血清 E2（调整后的优势比=34.62，95%置信区间=6.02-199.14）与 MAC-LD 独立相关，而低 DHEA-S 和睾酮则无相关性。ROC 分析表明，低血清 E2 水平与 MAC-LD 之间存在很强的关系（曲线下面积=0.947，95%置信区间=0.899-0.995）。即使对 17 例 MAC-LD 患者和 17 名健康对照组进行年龄和 BMI 匹配的亚组分析，也显示 MAC-LD 患者的血清 E2 水平低于健康对照组。此外，20 例 MAC-LD 患者的血清 E2 水平低于 11 例匹配的非-NTM BE 患者的血浆 E2 水平（1.79pg/mL 比 11.0pg/mL，p<0.001）。
结论
绝经后女性低血清 E2 水平与 MAC-LD 密切相关。
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