Lim Sung Yoon, Lee Yeon Joo, Park Jong Sun, Cho Young-Jae, Yoon Ho Il, Lee Choon-Taek, Lee Jae Ho
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Medicine (Baltimore). 2021 Apr 9;100(14):e25193. doi: 10.1097/MD.0000000000025193.
The incidence of pulmonary nontuberculous mycobacterial (NTM) infection is high in patients with underlying lung disease such as bronchiectasis. Although previous studies have reported many risk factors contributing to the development of NTM-lung disease (LD), only a few reports on the relationship of the characteristics of patients, such as body mass index (BMI), skeletal mass, and fat mass, with NTM-LD have been published. We aimed to investigate the association between these parameters and NTM-LD in patients with bronchiectasis.A monocentric retrospective study in a university hospital was conducted over 4 years (2013-2016). Parameters including BMI, skeletal mass, and fat mass were measured using bioelectrical impedance analysis in noncystic fibrosis bronchiectasis patients. Patients were grouped by the presence or absence of NTM-LD, and the differences in BMI, skeletal mass, and fat mass between the 2 groups were compared. In the NTM-LD group, the progression of disease was also followed.Two hundred forty-five patients with bronchiectasis were enrolled in the study. One hundred six subjects (48%) had NTM-LD. These patients with NTM-LD were predominantly female, and had a significantly lower body weight (58.20 ± 8.84 vs 54.16 ± 8.99, P < .001), BMI (22.67 ± 3.04 vs 21.20 ± 2.59 kg/m2, P < .001), fat mass (16.19 ± 6.60 vs 14.23 ± 5.79, P = .013), and fat mass index (FMI; 6.79 ± 2.70 vs 5.57 ± 2.27 kg/m2, P < .001). Multivariate regression analysis showed that both female sex and lower FMI but not skeletal muscle index were independent risk factors for NTM-LD after adjusting for age, bronchiectasis severity index, and BMI (odds ratio 3.86 (1.99-7.78); 0.72 (0.63-0.82), P < .001, respectively).Our results suggest that lower FMI may contribute to susceptibility to NTM infection in patients with bronchiectasis, independent of age or its severity.
在患有支气管扩张等潜在肺部疾病的患者中，肺部非结核分枝杆菌（NTM）感染的发生率很高。尽管先前的研究报告了许多导致NTM肺病（LD）发生的危险因素，但关于患者特征（如体重指数（BMI）、骨骼质量和脂肪质量）与NTM-LD之间关系的报道却很少。我们旨在研究支气管扩张患者中这些参数与NTM-LD之间的关联。
在一家大学医院进行了一项为期4年（2013 - 2016年）的单中心回顾性研究。使用生物电阻抗分析测量非囊性纤维化支气管扩张患者的BMI、骨骼质量和脂肪质量等参数。根据是否存在NTM-LD对患者进行分组，并比较两组之间BMI、骨骼质量和脂肪质量的差异。在NTM-LD组中，还对疾病进展进行了跟踪。
245例支气管扩张患者纳入研究。106例受试者（48%）患有NTM-LD。这些NTM-LD患者以女性为主，体重（58.20±8.84 vs 54.16±8.99，P <.001）、BMI（22.67±3.04 vs 21.20±2.59 kg/m²，P <.001）、脂肪质量（16.19±6.60 vs 14.23±5.79，P =.013）和脂肪质量指数（FMI；6.79±2.70 vs 5.57±2.27 kg/m²，P <.001）均显著较低。多变量回归分析显示，在调整年龄、支气管扩张严重程度指数和BMI后，女性和较低的FMI而非骨骼肌指数是NTM-LD的独立危险因素（优势比分别为3.86（1.99 - 7.78）；0.72（0.63 - 0.82），P <.001）。
我们的结果表明，较低的FMI可能导致支气管扩张患者易患NTM感染，且与年龄或疾病严重程度无关。
