Hyung Kwonhyung, Kim Sung-A, Kim Joong-Yub, Kwak Nakwon, Yim Jae-Joon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Chest. 2024 Sep;166(3):452-460. doi: 10.1016/j.chest.2024.03.024. Epub 2024 Mar 16.
The clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) is varied, and a watchful waiting management strategy is appropriate for a subset of patients. Understanding disease progression and risk factors for progression is essential for deciding on an appropriate follow-up strategy.
What is the rate of NTM-PD progression, and what are the predictors of progression?
Patients with NTM-PD who were enrolled in a prospective observational cohort study between July 1, 2011, and December 31, 2022, were included in this analysis. Clinical, bacterial, laboratory, and radiographic data were collected at enrollment and then regularly during follow-up. NTM-PD progression was defined as either the initiation of treatment or the clinician's intention to treat. The rate of progression was calculated and the predictors for progression were analyzed.
Of the 477 patients enrolled, NTM-PD progressed in 192 patients over a median follow-up of 5.4 years. The incidence of NTM-PD progression was 11.0 cases per 100 person-years (95% CI, 9.5-12.7 cases per 100 person-years). The proportion of patients experiencing disease progression was 21.4% at 1 year, 33.8% at 3 years, and 43.3% at 5 years. The final multivariable analysis model identified female sex (adjusted hazard ratio [aHR], 1.69; 95% CI, 1.19-2.39), elevated erythrocyte sedimentation rate (aHR, 1.79; 95% CI, 1.31-2.43), FEV % predicted (aHR, 0.89; 95% CI, 0.82-0.96), and the presence of a cavity (aHR, 2.78; 95% CI, 2.03-3.80) as predictors of progression.
About one-half of patients with NTM-PD experienced progression during an observation period of > 5 years. Patients with risk factors for progression should be observed closely.
ClinicalTrials.gov; No.: NCT01616745; URL: www.
gov.
非结核分枝杆菌肺病（NTM-PD）的临床病程各异，对于一部分患者而言，密切观察等待的管理策略是合适的。了解疾病进展情况以及进展的危险因素对于确定合适的随访策略至关重要。
NTM-PD的进展率是多少，进展的预测因素有哪些？
本分析纳入了2011年7月1日至2022年12月31日期间参加前瞻性观察队列研究的NTM-PD患者。在入组时以及随访期间定期收集临床、细菌学、实验室和影像学数据。NTM-PD进展定义为开始治疗或临床医生有治疗意向。计算进展率并分析进展的预测因素。
在纳入的477例患者中，在中位随访5.4年期间，192例患者出现NTM-PD进展。NTM-PD进展的发生率为每100人年11.0例（95%CI，每100人年9.5 - 12.7例）。1年时疾病进展患者的比例为21.4%，3年时为33.8%，5年时为43.3%。最终的多变量分析模型确定女性（调整后风险比[aHR]，1.69；95%CI，1.19 - 2.39）、红细胞沉降率升高（aHR，1.79；95%CI，1.31 - 2.43）、预测的第一秒用力呼气容积百分比（aHR，0.89；95%CI，0.82 - 0.96）以及有空洞（aHR，2.78；95%CI，2.03 - 3.80）为进展的预测因素。
在超过5年的观察期内，约一半的NTM-PD患者出现进展。具有进展危险因素的患者应密切观察。
ClinicalTrials.gov；编号：NCT01616745；网址：www. ClinicalTrials.gov 。
