Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan
Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan
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DOI：
10.1016/j.rmed.2019.05.001
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发表时间：
2019-06-01
影响因子：
4.3
通讯作者：
Sasaki, Yuka
中科院分区：
文献类型：
--
作者：
Furuuchi, Koji;Morimoto, Kozo;Sasaki, Yuka
背景和目标：在包括日本在内的许多工业化国家，非结核分枝杆菌肺病的发病率正在增加，而结核病的发病率正在下降。然而，NTM-PD与TB相关的临床流行病学特征的长期评估是有限的。我们的目的是澄清NTM-PD的流行病学和临床特征的长期变化与结核病在国家指定的TB center in Japanes.Methods：我们回顾了所有的分枝杆菌检查记录在福寿寺医院在2006年和2016年之间。NTM-PD病例根据2007年美国胸科学会/美国传染病学会微生物标准定义。结果：2000 ~ 2010年共确诊肺结核3,546例，非结核分枝杆菌肺结核2,155例。虽然肺结核病例的年发病数在研究期间保持稳定（P= 0.59），但NTM-PD病例的年发病数从165例显著增加至278例（P < 0.01）。肺结核病例的平均年龄从59.7 ± 16.3岁增加到66.2 ± 21.7岁，而NTM-PD病例的平均年龄保持不变。关于年龄分布，观察到75岁以上结核病患者和50-74岁NTM患者的增幅最大。NTM最常见的致病菌是鸟分枝杆菌复合群（87.3%）、M. sp. complex 5.5%）和M.堪萨斯州3.9%）。在MAC-PD患者中，结节性支气管扩张型NB的比例在2000年至2016年期间从60.0%显著增加至84.4%（P < 0.01）。NB型发病率男性为33.3%~ 70.7%（P < 0.01），女性为71.3%~ 89.2%（P < 0.01）。与结核病患者相比，新NTM-PD患者的平均年龄在过去10年中没有增加。在MAC-PD患者中，男女NB型所占比例均显著增加。
Background and objectives: The incidence of nontuberculous mycobacterial pulmonary disease NTM-PD) is increasing, while that of tuberculosis TB) is decreasing in many industrialized countries, including Japan. However, the long-term evaluation of clinico-epidemiological features of NTM-PD in relation to TB are limited. We aimed to clarify the long-term changes in the epidemiology and clinical features of NTM-PD in relation to those of TB at a nationally-designated TB center in Japan.Methods: We reviewed all mycobacterial examination records at Fukujuji Hospital between 2006 and 2016. Cases of NTM-PD were defined according to the 2007 American Thoracic Society/Infectious Disease Society of America microbiologic criteria. The current characteristics of Mycobacterium avium complex pulmonary disease MAC-PD) were compared with those in the 1980s and circa 2000.Results: We identified a total of 3,546 pulmonary TB cases and 2,155 NTM-PD cases. While the annual number of incident pulmonary TB cases remained stable over the study period P= 0.59), that of NTM-PD cases increased significantly from 165 to 278 P < 0.01). The mean age of pulmonary TB cases increased from 59.7 +/- 16.3 to 66.2 +/- 21.7 years, whereas that of NTM-PD cases remained unchanged. Regarding the age distribution, the greatest increases were observed in patients over 75 years for TB and in patients 50-74 years for NTM. The most common causative organism for NTM was Mycobacterium avium complex 87.3%), M. abscessus complex 5.5%) and M. kansasii 3.9%). Among patients with MAC-PD, the proportion of the nodular bronchiectatic NB) form increased significantly from 60.0% to 84.4% between circa 2000 and 2016 P < 0.01). Significant increases in the NB form were observed in both males 33.3%-70.7%, P < 0.01) and females 71.3%-89.2%, P < 0.01).Conclusions: The annual number of incident NTM-PD cases increased markedly. In contrast to patients with TB, the mean age of new NTM-PD patients did not increase in the last 10 years. Among MAC-PD patients, the proportions accounted for by the NB form increased significantly in both sexes.