University of Milan, Department of Pathophysiology and Transplantation, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit, Cystic Fibrosis Adult Center, Italy.
Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy.
Respir Med. 2020 Apr;164:105899. doi: 10.1016/j.rmed.2020.105899. Epub 2020 Feb 14.
Outcome recognition is a crucial step in the management of non-tuberculous mycobacteria lung disease (NTM-LD). In order to explore NTM-LD outcomes in a real-life setting, an observational, retrospective study enrolling consecutive adults who received treatment for NTM-LD in Milan, Italy, from 2007 to 2017 was conducted. Among 170 patients (68.2% females; median age: 68 years), NTM-LD was mainly due to M. avium complex (MAC) (71.2%), M. kansasii (9.4%) and M. xenopi (7.1%). Along a median follow-up of 31 months, adverse events occurred in 37.6% of the patients. Treatment outcomes of the entire study population included an unsuccessful outcome in 35.3% of the patients, including treatment halted in 13.5%, recurrence in 11.2%, re-infection in 5.3%, treatment failure in 4.1% and relapse in 1.2%. The main reason for treatment halted was drug intolerance. No differences were detected between patients with MAC-LD vs. those with other NTM-LD in terms of unsuccessful outcome in general (35.5% vs. 34.7%). A significantly higher prevalence of patients who underwent treatment halted was found in patients with NTM-LD other than MAC in comparison to patients with MAC-LD (22.4% vs. 9.9%, p = 0.030). One third of adults undergoing treatment for a NTM-LD experiences an unsuccessful outcome with adverse events and treatment discontinuation being major challenges in patients' management.
结局识别是非结核分枝杆菌肺病（NTM-LD）管理中的关键步骤。为了在真实环境中探索 NTM-LD 的结局，对 2007 年至 2017 年在意大利米兰接受 NTM-LD 治疗的连续成年患者进行了一项观察性、回顾性研究。在 170 名患者中（68.2%为女性；中位年龄：68 岁），NTM-LD 主要由鸟分枝杆菌复合群（MAC）（71.2%）、堪萨斯分枝杆菌（9.4%）和胞内分枝杆菌（7.1%）引起。在中位随访 31 个月期间，37.6%的患者发生不良事件。整个研究人群的治疗结局包括 35.3%的患者治疗不成功，包括 13.5%的患者停止治疗、11.2%的患者复发、5.3%的患者再感染、4.1%的患者治疗失败和 1.2%的患者病情复发。停止治疗的主要原因是药物不耐受。MAC-LD 患者与其他 NTM-LD 患者在总体治疗不成功方面无差异（35.5%vs.34.7%）。与 MAC-LD 患者相比，除 MAC 以外的 NTM-LD 患者中停止治疗的患者比例显著更高（22.4%vs.9.9%，p=0.030）。三分之一接受 NTM-LD 治疗的成年人经历治疗失败和不良事件，治疗停止是患者管理中的主要挑战。
