Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, Tokyo, Japan.
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
PLoS One. 2023 Feb 8;18(2):e0281103. doi: 10.1371/journal.pone.0281103. eCollection 2023.
Semi-quantitative CT score is generally used for evaluating the disease status of Mycobacterium abscessus (Mab) Pulmonary disease (Mab-PD). However, its accuracy and clinical usefulness are limited, since the CT score is largely affected by coexisting lung disease. Hence, we hypothesized that numerical change in CT score during the observation period may be useful for evaluating disease activity of Mab-PD.
Patients diagnosed with Mab-PD based on the official ATS/ERS/ESCMID/IDSA statement at Jikei University Hospital and Jikei Daisan Hospital between 2015 January 1 and 2021 July 31 were included (n = 32). We reviewed the medical records, and bacteriological and laboratory data of the patients. Chest CT was performed at diagnosis in all 32 cases. In 18 cases, chest CT images within 4 years before diagnosis were available. The numerical change in CT score between two time points was calculated and the association of the CT scores with sputum Gaffky score and serum CRP was examined.
CT score at diagnosis was not correlated with sputum Gaffky score nor serum CRP, while the difference of absolute value and change rate in CT score between at diagnosis and immediate past CT were well correlated with both sputum Gaffky score and serum CRP.
Chronological change in CT score may more precisely reflect the disease activity of airway mycobacterial burden and systemic inflammation in Mab-PD at the timing of diagnosis.
半定量 CT 评分通常用于评估脓肿分枝杆菌（Mab）肺病（Mab-PD）的疾病状态。然而，由于 CT 评分在很大程度上受到并存肺部疾病的影响，其准确性和临床实用性有限。因此，我们假设在观察期间 CT 评分的数值变化可能有助于评估 Mab-PD 的疾病活动。
2015 年 1 月 1 日至 2021 年 7 月 31 日期间，在日本顺天堂大学医院和日本顺天堂第三医院，根据美国胸科学会/欧洲呼吸学会/欧洲临床微生物学和感染病学会/美国感染病学会官方声明诊断为 Mab-PD 的患者被纳入研究（n=32）。我们复习了患者的病历、细菌学和实验室数据。所有 32 例患者在诊断时均行胸部 CT 检查，18 例患者在诊断前 4 年内有胸部 CT 图像。计算了两个时间点之间 CT 评分的数值变化，并检查了 CT 评分与痰 Gaffky 评分和血清 CRP 的相关性。
诊断时的 CT 评分与痰 Gaffky 评分或血清 CRP 均无相关性，而 CT 评分绝对值的变化和诊断时与最近一次 CT 之间的变化率与痰 Gaffky 评分和血清 CRP 均有很好的相关性。
在 Mab-PD 诊断时，CT 评分的时间变化可能更精确地反映气道分枝杆菌负荷和全身炎症的疾病活动。
