Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
BMC Pulm Med. 2024 Oct 24;24(1):531. doi: 10.1186/s12890-024-03337-7.
The characteristics of bronchiectasis (BE) in Asia, including Japan, remain largely unknown. We aimed to provide insights into the clinical characteristics and treatment outcomes of BE, especially regarding nontuberculous mycobacteria (NTM) infection and its poorly understood impact on prognosis. We also aimed to clarify the effect of long-term macrolide antibiotic use in patients with BE, who had no history of exacerbations.
In this single-center, retrospective study, the medical records of patients who satisfied the BE criteria between January 1, 2012, and August 31, 2023, were reviewed. Severe exacerbations and mortality during the observation period were recorded. Baseline characteristics and overall survival of patients with and without NTM infection, and factors influencing the time to the first exacerbation and death were analyzed. Additionally, the effects of long-term macrolide antibiotic use in patients without a history of severe exacerbations were estimated.
In a cohort of 1044 patients with BE, the rate of severe exacerbation was 22.3%, with mortality rates of 3.2% over 3 years. Notably, the high prevalence of NTM infection (n = 410, 39.3%) in this cohort was distinctive. NTM infection was not associated with either the time to first severe exacerbation (p = 0.5676, adjusted hazard ratio = 1.11) or mortality (p = 0.4139, adjusted hazard ratio = 0.78). Compared with the NTM group, the non-NTM group had a higher proportion of elevated inflammatory markers, with significant differences in C-reactive protein levels (p = 0.0301) and blood neutrophil counts (p = 0.0273). Pseudomonas aeruginosa colonization was more frequent in the non-NTM group (p = 0.0003). Among patients with non-NTM infection and without a history of exacerbation in the past 2 years, 38.2% received long-term macrolide antibiotics that did not invariably prolong the time to first severe exacerbation (p = 0.4517, IPW p = 0.3555).
This study highlights BE epidemiology in Japan, noting that the presence of NTM infection may not necessarily worsen the prognostic outcomes and advising caution in the casual use of macrolides for milder cases without a history of exacerbations.
UMIN Clinical Trials Registry Number: UMIN000054726 (Registered on 21 June 2024).
亚洲（包括日本）支气管扩张症（BE）的特征在很大程度上仍不清楚。我们旨在深入了解 BE 的临床特征和治疗结果，特别是针对非结核分枝杆菌（NTM）感染及其对预后影响的研究。我们还旨在阐明在无加重史的 BE 患者中，长期使用大环内酯类抗生素的效果。
在这项单中心回顾性研究中，我们回顾了 2012 年 1 月 1 日至 2023 年 8 月 31 日期间符合 BE 标准的患者的病历。记录了观察期间的严重加重和死亡情况。分析了有无 NTM 感染患者的基线特征和总生存率，以及影响首次加重和死亡时间的因素。此外，还估计了无严重加重史患者长期使用大环内酯类抗生素的效果。
在 1044 例 BE 患者中，严重加重率为 22.3%，3 年内死亡率为 3.2%。值得注意的是，该队列中 NTM 感染的高患病率（n=410，39.3%）很显著。NTM 感染与首次严重加重的时间（p=0.5676，调整后的危险比=1.11）或死亡率（p=0.4139，调整后的危险比=0.78）无关。与 NTM 组相比，非 NTM 组有更高比例的炎症标志物升高，C 反应蛋白水平（p=0.0301）和血中性粒细胞计数（p=0.0273）有显著差异。非 NTM 组中铜绿假单胞菌定植更为常见（p=0.0003）。在无 NTM 感染且过去 2 年内无加重史的患者中，38.2%接受了长期大环内酯类抗生素治疗，但这并未延长首次严重加重的时间（p=0.4517，加权倾向得分 p=0.3555）。
本研究强调了日本 BE 的流行病学特点，指出 NTM 感染的存在不一定会恶化预后结果，并建议在没有加重史的轻度病例中谨慎使用大环内酯类药物。
UMIN 临床研究注册编号：UMIN000054726（2024 年 6 月 21 日注册）。
