Tanaka Yasuhiro, Ide Shotaro, Takazono Takahiro, Takeda Kazuaki, Iwanaga Naoki, Yoshida Masataka, Hosogaya Naoki, Tsukamoto Yusei, Irifune Satoshi, Suyama Takayuki, Mihara Tomo, Kondo Akira, Kobayashi Tsutomu, Fukuda Yuichi, Sasaki Eisuke, Sawai Toyomitsu, Higashiyama Yasuhito, Hashiguchi Kohji, Hanaka Minako, Ii Toshihiko, Fukushima Kiyoyasu, Komiya Kosaku, Miyazaki Taiga, Yatera Kazuhiro, Izumikawa Koichi, Furumoto Akitsugu, Yanagihara Katsunori, Mukae Hiroshi
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo, Japan.
Mycoses. 2025 Jun;68(6):e70083. doi: 10.1111/myc.70083.
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with increasing prevalence and mortality worldwide. Coinfection with chronic pulmonary aspergillosis (CPA) is a significant complication of NTM-PD, often complicating treatment and resulting in poor prognosis.
In this multicentre, retrospective cohort study, we examined the epidemiology, comorbidities, risk factors for CPA coinfection and long-term prognosis of patients with NTM-PD infected with CPA in Japan.
Patients aged ≥ 18 years with newly diagnosed NTM-PD who visited 18 hospitals between 2010 and 2017 in Kyushu, Japan, were included. Medical records were reviewed for patient characteristics, mycobacterial species, laboratory data, radiological features, Aspergillus coinfection and all-cause mortality rates. Risk factors for CPA coinfection were analysed using multiple logistic regression, and survival analysis was performed before and after propensity score matching with risk factors.
Among 1304 patients with NTM-PD, 45 (3.5%) were diagnosed with CPA, including 42 with chronic progressive pulmonary aspergillosis. The risk factors for CPA coinfection included male sex, chronic obstructive pulmonary disease, oral corticosteroid use and cavity formation. All-cause mortality was significantly higher in patients with NTM-PD with CPA than in those without CPA (log-rank test, p < 0.001; crude hazard ratio [HR], 3.98). Survival analysis after propensity score matching suggested CPA was an independent poor prognostic factor (log-rank test, p = 0.036; adjusted HR, 1.59).
CPA is an independent poor prognostic factor in patients with NTM-PD. Clinicians must consider CPA when treating patients with NTM-PD, particularly those with high-risk factors, to ensure timely diagnosis and management.
非结核分枝杆菌肺病（NTM-PD）是一种慢性呼吸道感染，在全球范围内患病率和死亡率均呈上升趋势。合并慢性肺曲霉病（CPA）是NTM-PD的一种严重并发症，常使治疗复杂化并导致预后不良。
在这项多中心回顾性队列研究中，我们调查了日本NTM-PD合并CPA感染患者的流行病学、合并症、CPA合并感染的危险因素及长期预后。
纳入2010年至2017年期间在日本九州18家医院就诊的年龄≥18岁、新诊断为NTM-PD的患者。回顾病历以获取患者特征、分枝杆菌种类、实验室数据、放射学特征、曲霉合并感染情况及全因死亡率。使用多因素logistic回归分析CPA合并感染的危险因素，并在对危险因素进行倾向评分匹配前后进行生存分析。
在1304例NTM-PD患者中，45例（3.5%）被诊断为CPA，其中42例为慢性进行性肺曲霉病。CPA合并感染的危险因素包括男性、慢性阻塞性肺疾病、口服糖皮质激素使用及空洞形成。NTM-PD合并CPA的患者全因死亡率显著高于未合并CPA的患者（log-rank检验，p<0.001；粗风险比[HR]，3.98）。倾向评分匹配后的生存分析表明，CPA是一个独立的不良预后因素（log-rank检验，p=0.036；调整后HR，1.59）。
CPA是NTM-PD患者的一个独立不良预后因素。临床医生在治疗NTM-PD患者时，尤其是那些具有高危因素的患者，必须考虑CPA，以确保及时诊断和管理。
