Levels of Antibody against Glycopeptidolipid Core as a Marker for Monitoring Treatment Response in Mycobacterium avium Complex Pulmonary Disease: a Prospective Cohort Study
Levels of Antibody against Glycopeptidolipid Core as a Marker for Monitoring Treatment Response in Mycobacterium avium Complex Pulmonary Disease: a Prospective Cohort Study
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DOI：
10.1128/jcm.02010-16
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发表时间：
2017-03-01
影响因子：
9.4
通讯作者：
Kobayashi, Kazuo
中科院分区：
文献类型：
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作者：
Kitada, Seigo;Maekura, Ryoji;Kobayashi, Kazuo
鸟分枝杆菌复合群肺病（MAC-PD）的诊断有时复杂且耗时。测量针对糖肽脂（GPL）核心的伊加抗体的血清水平的血清诊断试剂盒是市售的，并且对MAC-PD具有良好的诊断准确性。然而，GPL核心伊加抗体水平的测量在监测MAC-PD患者化疗反应中的意义尚未得到充分研究。入组了34例开始接受多药化疗的初治MAC-PD患者。定期前瞻性测量他们的抗体水平。检查其抗体水平与治疗结果之间的关系。根据化疗后的细菌学结果，将患者分为三组（转化、复发和未转化）。治疗前培养物转化组（n = 19）、复发组（n = 7）和未转化组（n = 8）之间的抗体水平无显著差异（P = 0.9881）。化疗后明显下降（P = 0.0001）。在停止化疗后抗体水平随后升高的病例中，观察到胸部放射学检查结果复发和/或恶化。在培养物转化组和复发组之间，观察到化疗导致的抗体水平下降百分比无显著差异（P = 0.9338）。初始抗体水平不是治疗结果的预测因子，并且抗体水平的百分比降低也不是化疗停止的充分指标。然而，抗体水平的连续测量可以允许客观监测个体MAC-PD患者的疾病活动。
The diagnosis of Mycobacterium avium complex pulmonary disease (MAC-PD) is sometimes complicated and time-consuming. A serodiagnostic kit that measures the serum levels of IgA antibodies against the glycopeptidolipid (GPL) core is commercially available and has good diagnostic accuracy for MAC-PD. However, the significance of measurement of GPL core IgA antibody levels in monitoring for chemotherapy response in patients with MAC-PD was not well investigated. Thirty-four treatment naive MAC-PD patients who were started on multidrug chemotherapy were enrolled. Their antibody levels were prospectively measured at regular intervals. The relationships between their antibody levels and the therapeutic outcomes were examined. The patients were classified into three groups (conversion, recurrence, and nonconversion) based on the bacteriological outcomes after chemotherapy. There were no significant differences in the antibody levels before treatment between the culture conversion (n = 19), recurrence (n = 7), and nonconversion (n = 8) groups (P = 0.9881). The levels decreased significantly after the chemotherapy (P = 0.0001). Recurrence and/or worsening of chest radiography findings were observed in cases whose antibody levels subsequently increased after cessation of the chemotherapy. No significant difference in the percent decrease in antibody levels by the chemotherapy was observed between the culture conversion and recurrence groups (P = 0.9338). The initial antibody levels are not a predictor of therapeutic outcomes, and also the percent decrease in antibody levels is not a sufficient indicator of the cessation of chemotherapy. However, serial measurements of antibody levels may allow objective monitoring of disease activity in individual MAC-PD patients.