Watanabe Chie, Suematsu Ryohei, Sano Tomoya, Hamamoto Takaaki, Maki Yohei, Ito Koki, Sugiura Hiroaki, Shinmoto Hiroshi, Kawana Akihiko, Kimizuka Yoshifumi
Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Department of Clinical Laboratory, National Defense Medical College Hospital, Saitama, Japan.
Heliyon. 2023 Aug 6;9(8):e18967. doi: 10.1016/j.heliyon.2023.e18967. eCollection 2023 Aug.
The radiographic features of complex pulmonary disease (MAC-PD), a major component of nontuberculous mycobacteria, consist of a variety of lesions; however, the responsiveness of each type of radiographic factor to treatment is unclear. Thus, we evaluated the longitudinal changes of each factor in serial computed tomography (CT) images using a mixed-effects model, and investigated the radiographic transition in patients with MAC-PD whose progress could be followed.
In this retrospective study, eighty-four patients diagnosed with MAC-PD and with yearly CT records were recruited after a review of 328 medical records with culture-positive MAC in respiratory specimens. The study participants were divided into two groups: treatment (n = 43) and no-treatment (n = 41) groups. Radiographic images were scored using the nodule (N), infiltration (I), cavity (C), ectasis (E) scoring system. Longitudinal changes in each radiographic lesion factor were analyzed using a mixed-effects model in treated and untreated patients.
All factors tended to progress without treatment, and significant longitudinal changes were observed in the N, I, and E factors (N: = 0.010, I: = 0.004, E: < 0.001). Although treatment tended to improve N and I in radiographic images (N: = 0.006, I: = 0.203), cavities and ectasis progressed, regardless of treatment (C: = 0.057 and E: = 0.033).
Radiographic changes of MAC-PD can be categorized into reversible (nodules and infiltrations) and irreversible (cavities and ectasis) lesions. Early treatment may prevent the accumulation of irreversible factors.
非结核分枝杆菌的主要组成部分——复杂性肺部疾病（MAC-PD）的影像学特征包括多种病变；然而，每种影像学因素对治疗的反应尚不清楚。因此，我们使用混合效应模型评估了连续计算机断层扫描（CT）图像中各因素的纵向变化，并研究了病情可跟踪的MAC-PD患者的影像学转变情况。
在这项回顾性研究中，在对328份呼吸道标本中培养阳性MAC的病历进行审查后，招募了84名诊断为MAC-PD且有年度CT记录的患者。研究参与者分为两组：治疗组（n = 43）和未治疗组（n = 41）。使用结节（N）、浸润（I）、空洞（C）、扩张（E）评分系统对影像学图像进行评分。使用混合效应模型分析治疗组和未治疗组患者中各影像学病变因素的纵向变化。
所有因素在未治疗时均有进展趋势，并且在N、I和E因素中观察到显著的纵向变化（N：= 0.010，I：= 0.004，E：< 0.001）。尽管治疗倾向于改善影像学图像中的N和I（N：= 0.006，I：= 0.203），但无论是否治疗，空洞和扩张均有进展（C：= 0.057，E：= 0.033）。
MAC-PD的影像学变化可分为可逆性（结节和浸润）和不可逆性（空洞和扩张）病变。早期治疗可能会阻止不可逆因素的积累。
