Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, Tokyo, Japan.
Respir Med. 2024 May;226:107627. doi: 10.1016/j.rmed.2024.107627. Epub 2024 Apr 9.
Although international nontuberculous mycobacterial pulmonary disease (NTM-PD) guidelines highlight symptom presence at diagnosis, the clinical characteristics of asymptomatic Mycobacterium avium complex pulmonary infection (MAC-PI) patients remain understudied. We clarified the clinical characteristics and course of asymptomatic MAC-PI patients.
We retrospectively analyzed 200 consecutive patients with MAC-PIs and adequate available data who newly met the microbiological and radiological criteria for NTM-PD at Fukujuji Hospital from January 2018 to June 2020. We compared the clinical characteristics and course of asymptomatic patients with symptomatic patients and evaluated factors influencing treatment initiation through multivariate analysis.
111 patients were symptomatic and 89 were asymptomatic at diagnosis. While the proportion was significantly lower than that in the symptomatic group (28.8 %), 15.7 % of asymptomatic group patients had cavitary lesions (P = 0.042). In the asymptomatic group, treatments were initiated in 38 (42.7 %) patients, and cavitary lesions, a positive acid-fast bacilli smear, and younger age were independent risk factors for treatment initiation. Among 22 (57.9 %) patients who experienced disease progression necessitating treatment during follow-up, 13 (34.2 %) displayed radiological progression without any worsening of symptoms. Agents used for treatment were consistent across the groups, with no significant differences in culture conversion, microbiological recurrence rates, or spontaneous culture conversion rates.
Routine health checkups and radiological examinations can detect clinically important MAC-PIs even in the absence of symptoms. Considering that the clinical course of asymptomatic MAC-PI patients is largely similar to that of symptomatic patients, timely and appropriate management and intervention are essential for all MAC-PI patients.
尽管国际非结核分枝杆菌肺病（NTM-PD）指南强调了诊断时症状的存在，但无症状鸟分枝杆菌复合群肺部感染（MAC-PI）患者的临床特征仍研究不足。我们阐明了无症状 MAC-PI 患者的临床特征和病程。
我们回顾性分析了 2018 年 1 月至 2020 年 6 月在福聚寺医院新符合 NTM-PD 微生物学和影像学标准的 200 例连续 MAC-PI 患者，且有足够的可用数据。我们比较了无症状和有症状患者的临床特征和病程，并通过多变量分析评估了影响治疗开始的因素。
111 例患者有症状，89 例患者在诊断时无症状。虽然无症状组的比例明显低于有症状组（28.8%），但 15.7%的无症状组患者有空洞病变（P=0.042）。在无症状组中，38 例（42.7%）患者开始治疗，有空洞病变、抗酸杆菌涂片阳性和年龄较小是开始治疗的独立危险因素。在 22 例（57.9%）在随访期间因疾病进展需要治疗的患者中，有 13 例（34.2%）表现为影像学进展而无任何症状恶化。各组使用的治疗药物相同，培养转化率、微生物学复发率或自发培养转化率均无显著差异。
常规健康检查和影像学检查可以发现即使无症状也具有临床重要性的 MAC-PI。考虑到无症状 MAC-PI 患者的临床病程与有症状患者基本相似，及时、适当的管理和干预对所有 MAC-PI 患者都很重要。
