Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
Epidemiol Infect. 2021 Apr 27;149:e117. doi: 10.1017/S0950268821000960.
No previous studies have examined Mycobacterium avium complex pulmonary disease (MAC-PD) in only elderly patients ⩾75 years old. Here, we investigated the exacerbating factors of MAC-PD in elderly patients and clarified cases that can be followed up without MAC medication. From April 2011 to March 2019, 126 advanced aged patients at our institute were newly diagnosed with MAC-PD, and could be observed based on radiological findings for over a year. Their medical records were retrospectively examined for clinical and radiological findings at the time of diagnosis and 1 year later. To identify the predictors of exacerbation, clinical characteristics of 109 treatment-naïve patients were compared between exacerbated and unchanged groups. Additionally, the unchanged group was followed for one more year. In the current study, positive acid-fast bacilli smears from the sputum test, the presence of cavitary lesions and extensive radiological findings, particularly abnormal shadows in ⩾3 lobes, were predictive of exacerbation among treatment-naïve elderly MAC-PD patients. In the unchanged group, <10% showed exacerbation of radiological findings within the subsequent year. In conclusion, if the sputum smear is negative, no cavitary lesions are present, and abnormal shadows are restricted to ⩽2 lobes, elderly patients with MAC-PD may remain untreated for a few years.
先前的研究尚未专门针对仅 75 岁及以上的老年患者的鸟分枝杆菌复合群肺病（MAC-PD）进行研究。在这里，我们调查了老年患者 MAC-PD 的加重因素，并阐明了无需使用 MAC 药物即可进行随访的病例。2011 年 4 月至 2019 年 3 月，我院新诊断出 126 例患有 MAC-PD 的高龄患者，根据影像学检查结果，他们可以观察一年以上。回顾性检查了他们在诊断时和 1 年后的临床和影像学发现的病历。为了确定恶化的预测因素，将 109 例未经治疗的初治患者的临床特征在恶化组和未改变组之间进行了比较。此外，未改变组又随访了一年。在本研究中，痰检中阳性抗酸杆菌涂片、有空腔病变和广泛的影像学发现，特别是 ⩾3 个肺叶中的异常阴影，是未经治疗的老年 MAC-PD 患者恶化的预测因素。在未改变组中，<10%的患者在随后的一年中出现影像学发现恶化。总之，如果痰涂片阴性、不存在空洞病变且异常阴影局限于 ⩽2 个肺叶，MAC-PD 老年患者可能无需治疗数年。
