Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis
Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis
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DOI：
10.1136/thoraxjnl-2012-201772
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发表时间：
2013-03-01
期刊：
影响因子：
10
通讯作者：
Thomsen, Reimar Wernich
中科院分区：
文献类型：
--
作者：
Andrejak, Claire;Nielsen, Rikke;Thomsen, Reimar Wernich
慢性呼吸系统疾病和吸入皮质类固醇（ICS）治疗慢性阻塞性肺疾病（COPD）会增加肺炎的风险。关于这些危险因素与非结核分枝杆菌（NTM）肺部疾病之间的关联，目前的数据很少。方法：在一项以人群为基础的病例对照研究中，研究了慢性呼吸系统疾病和ICS的使用作为危险因素，该研究涵盖了1997年至2008年间丹麦所有微生物学证实的NTM肺病成年人。该研究包括每个病例10个匹配的人群对照。采用条件logistic回归计算NTM肺部疾病与慢性呼吸系统疾病史相关的调整后ORs。结果：总体而言，慢性呼吸系统疾病与NTM肺病风险增加16.5倍（95% CI 12.2 - 22.2）相关。慢性阻塞性肺病NTM疾病的调整OR为15.7 (95% CI 11.4 ~ 21.5)，哮喘为7.8 (95% CI 5.2 ~ 11.6)，尘肺为9.8 (95% CI 2.03 ~ 52.8)，支气管扩张为187.5 (95% CI 24.8 ~ 1417.4)，结核病史为178.3 （95% CI 55.4 ~ 574.3）。目前接受ICS治疗的COPD患者的or值为29.1 (95% CI 13.3至63.8)，而从未接受过ICS治疗的COPD患者的or值为7.6 （95% CI 3.4至16.8）。COPD患者的ORs随ICS剂量的增加而增加，从低剂量的28.1增加到高剂量（超过800 μ g/天）的47.5。氟替卡松的OR高于布地奈德。结论慢性呼吸系统疾病，特别是慢性阻塞性肺病，是NTM肺病的重要危险因素。
Background Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease.Methods This study examined chronic respiratory diseases and ICS use as risk factors in a population-based case-control study encompassing all adults in Denmark with microbiologically confirmed NTM pulmonary disease between 1997 and 2008. The study included 10 matched population controls per case. Conditional logistic regression was used to compute adjusted ORs for NTM pulmonary disease with regard to chronic respiratory disease history.Results Overall, chronic respiratory disease was associated with a 16.5-fold (95% CI 12.2 to 22.2) increased risk of NTM pulmonary disease. The adjusted OR for NTM disease was 15.7 (95% CI 11.4 to 21.5) for COPD, 7.8 (95% CI 5.2 to 11.6) for asthma, 9.8 (95% CI 2.03 to 52.8) for pneumoconiosis, 187.5 (95% CI 24.8 to 1417.4) for bronchiectasis, and 178.3 (95% CI 55.4 to 574.3) for tuberculosis history. ORs were 29.1 (95% CI 13.3 to 63.8) for patients with COPD on current ICS therapy and 7.6 (95% CI 3.4 to 16.8) for patients with COPD who had never received ICS therapy. Among patients with COPD, ORs increased according to ICS dose, from 28.1 for low-dose intake to 47.5 for high-dose intake (more than 800 mu g/day). The OR was higher for fluticasone than for budesonide.Conclusion Chronic respiratory disease, particularly COPD treated with ICS therapy, is a strong risk factor for NTM pulmonary disease.