The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome
The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome
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DOI：
10.1186/s12931-020-01420-1
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发表时间：
2020-06-16
影响因子：
5.8
通讯作者：
Kida, Hiroshi
中科院分区：
文献类型：
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作者：
Fukushima, Kiyoharu;Miki, Mari;Kida, Hiroshi
背景：据报道，非结核分枝杆菌肺病（NTM-PD）患者的肺切除术与良好的结局相关。然而，关于难治性和复发性病例的风险和预后因素知之甚少。我们的目的是通过比较接受辅助肺切除术的NTM-PD患者与仅接受抗生素治疗的患者，评估辅助肺手术的总体影响和获益。我们还研究了血清伊加抗体对糖肽脂（GPL）核心抗原（GPL核心抗体）监测疾病活动和预测辅助肺切除术后疾病复发的疗效。方法回顾性分析35例经手术治疗的NTM-PD患者的临床特点和手术疗效。此外，我们比较了手术治疗的患者和对照组患者，这些患者仅用抗生素治疗，使用根据年龄、性别、体重指数和疾病的放射学特征计算的倾向评分，在统计学上1：1匹配。结果手术治疗的患者中位年龄为58岁（四分位距，47-65岁），女性占65.7%。28例为鸟分枝杆菌复合群。手术包括4例全肺切除术、2例双叶切除术、1例双叶切除加肺段切除术、17例肺叶切除术、2例肺段切除术和9例肺叶切除加肺段切除术。术后并发症7例（20%），无手术死亡，痰培养阴转33例（94.3%）。难治性和复发性病例与残余支气管扩张、对侧阴影和抗酸杆菌染色或培养阳性有关。在28对统计学匹配的患者中，23例（82.2%）手术组患者和14例（50.0%）非手术组患者（0.0438）观察到长期持续的阴性培养转换。手术组的死亡率较低，但未达到统计学显著性（手术组1例，非手术组4例，p = 0.3516）。GPL核心抗体与疾病活动性和复发相关。结论：接受辅助肺切除术的NTM-PD患者总体结局良好，痰培养转化率更高。长期死亡率可能已经降低了这个程序，GPL核心抗体的水平被证明是一个很好的临床指标的疾病活动后手术。
Background Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection. Methods We retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease. Results In the surgically treated patients, the median age was 58 (interquartile range, 47-65) years and 65.7% were female. Twenty-eight patients hadMycobacterium aviumcomplex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group,p = 0.3516). GPL core antibody was correlated with disease activity and recurrence. Conclusions NTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.