Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
PLoS One. 2021 Apr 1;16(4):e0249455. doi: 10.1371/journal.pone.0249455. eCollection 2021.
Chronic pulmonary aspergillosis (CPA) develops in various underlying pulmonary conditions. There is scarce data evaluating interstitial lung disease (ILD)/abnormalities (ILA) as such conditions, and it has not been explored much whether non-tuberculous mycobacterial pulmonary disease (NTM-PD) is a prognostic factor for mortality in CPA patients. Few reports had investigated prognostic factors of CPA including underlying pulmonary conditions.
To explore prognostic factors of CPA including pulmonary conditions.
We conducted a retrospective cohort study of 264 CPA patients from a center for pulmonary aspergillosis in Japan.
Survival rates were 78.7%, 61.0%, and 47.4% at 1, 3, and 5 years, respectively. Of 264 patients, 53 (20.1%) and 87 (33.1%) were complicated with ILA and NTM-PD. Several independent prognostic factors were identified by multivariate Cox proportional analysis: ILA (HR 1.76, 95%CI 1.06-2.92, p = 0.029), age (1.05, 1.02-1.08, p<0.001), male sex (2.48, 1.34-4.59, p = 0.004), body mass index of <18.5 kg/m2 (1,87, 1.20-2.90, p = 0.005), presence of aspergilloma (1.59, 1.04-2.45, p = 0.033), and lower serum albumin (0.56, 0.38-0.83, p = 0.004). NTM-PD was not associated with higher mortality (0.85, 0.52-1.38, p = 0.51).
The poor prognosis of CPA and several prognostic factors were revealed. Early diagnosis and intervention is required with reference to such factors.
慢性肺曲霉病（CPA）可在各种基础肺部疾病中发展。关于特发性肺间质纤维化/异常（ILA）等疾病的数据很少，而非结核分枝杆菌肺病（NTM-PD）是否是 CPA 患者死亡率的预后因素也尚未得到充分探讨。很少有报告探讨包括基础肺部疾病在内的 CPA 的预后因素。
探讨包括肺部疾病在内的 CPA 的预后因素。
我们对来自日本肺曲霉病中心的 264 例 CPA 患者进行了回顾性队列研究。
1、3、5 年的生存率分别为 78.7%、61.0%和 47.4%。在 264 例患者中，53 例（20.1%）和 87 例（33.1%）并发 ILA 和 NTM-PD。多变量 Cox 比例分析确定了几个独立的预后因素：ILA（HR 1.76，95%CI 1.06-2.92，p=0.029）、年龄（1.05，1.02-1.08，p<0.001）、男性（2.48，1.34-4.59，p=0.004）、BMI<18.5kg/m2（1.87，1.20-2.90，p=0.005）、曲霉球存在（1.59，1.04-2.45，p=0.033）和血清白蛋白水平较低（0.56，0.38-0.83，p=0.004）。NTM-PD 与更高的死亡率无关（0.85，0.52-1.38，p=0.51）。
揭示了 CPA 的不良预后和几个预后因素。需要根据这些因素进行早期诊断和干预。
