Long-Term Prognosis and Antimycobacterial Glycolipid Antibody as Biomarker in Mycobacterium avium-intracellulare Complex Pulmonary Disease.
Long-Term Prognosis and Antimycobacterial Glycolipid Antibody as Biomarker in Mycobacterium avium-intracellulare Complex Pulmonary Disease.
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DOI：
10.1128/spectrum.00530-22
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发表时间：
2022-06-29
影响因子：
3.7
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中科院分区：
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在过去的十年中，多药化疗的临床特征和结局已被用作鸟-细胞内分枝杆菌复合性肺病（MAC-PD）的主要预后因素;然而，尚未报道有用的预后生物标志物。目的是确定血清抗体滴度是否可以包括有用的MAC-PD的预后预测因子。94例MAC-PD患者入组并定期随访5年以上或直至死亡。考克斯比例风险回归和受试者工作特征（ROC）曲线分析被用来确定在这项前瞻性观察性研究的死亡率预测因子。根据治疗结果，85例患者完成随访，并分为四组。17名患者（20%）在随访期间死亡（中位数，10.1年;四分位数间距，8.1至12.4年）。所有11名MAC-PD特异性死亡患者均纳入对多药化疗无反应的14名患者中。抗分枝杆菌糖脂（MBGL）抗体滴度明显高于其他组，生存预后明显较差（P < 0.0001）。抗MBGL抗体滴度也是一个阴性预后因素。根据临床不良预后特征和抗MBGL抗体滴度计算的临界评分为7分，在基线时区分无应答组和其他组（灵敏度、特异性和曲线下面积：分别为92.9%、81.7%和0.95）。总之，抗MBGL抗体滴度可用于评估难治性MAC-PD。结合抗MBGL抗体和临床不良预后特征，可以更准确地预测治疗结局和死亡率。重要性MAC-PD的自然病程在诊断时预测免疫功能正常的患者具有挑战性，目前的多药化疗方案不足以消除肺部的分枝杆菌。因此，MAC-PD的诊断并不一定导致开始化疗的决定。我们还观察到难治性患者在临床实践中，谁是耐多药化疗，并显示MAC杆菌的持续排泄和胸部放射学检查结果进行性恶化，直到死亡。我们已经报道，在这项研究中，抗MBGL抗体滴度的测量有助于评估难治性MAC-PD。此外，除了年龄较大、体重指数较低、抗酸菌（AFB）涂片试验阳性和存在空洞性疾病等临床预后不良特征外，使用抗MBGL抗体可更准确地预测治疗结局和死亡率。
Clinical characteristics and outcomes of multidrug chemotherapy have been used as the main prognostic factors for Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) over the last decade; however, no useful prognostic biomarkers have been reported. The aim is to ascertain whether the serum antibody titers could include useful prognostic predictors of MAC-PD. Ninety-four patients with MAC-PD were enrolled and regularly followed up with for more than 5 years or until death. Cox proportional hazard regression and receiver operating characteristic (ROC) curve analyses were used to identify predictors of mortality in this prospective observational study. According to treatment outcomes, 85 patients completed follow-up and were classified into four groups. Seventeen patients (20%) died during follow-up (median, 10.1 years; interquartile range, 8.1 to 12.4 years). All 11 patients with MAC-PD-specific death were included in the 14 patients of the group nonresponsive to the multidrug chemotherapy. They had significantly higher anti-Mycobacterium glycolipid (MBGL) antibody titers than those in the other groups and a significantly (P < 0.0001) poorer survival prognosis. The anti-MBGL antibody titers also served as a negative prognostic factor. A cutoff score of 7, which was calculated by clinical poor prognostic characteristics and anti-MBGL antibody titers, differentiated the nonresponse group and the other groups at baseline (sensitivity, specificity, and area under the curve: 92.9%, 81.7%, and 0.95, respectively). In conclusion, anti-MBGL antibody titers were useful to assess the refractory MAC-PD. The predictions of treatment outcome and mortality become more accurate by using anti-MBGL antibody and clinical poor prognostic characteristics together. IMPORTANCE The natural history of MAC-PD is challenging to predict in immunocompetent patients at diagnosis, and the current multidrug chemotherapy options are not strong enough to eliminate mycobacteria from the lungs. Therefore, the diagnosis of MAC-PD does not necessarily lead to the decision to start chemotherapy. We have also observed refractory patients in clinical practice, who were resistant to multiple-drug chemotherapy and showed persistent excretion of MAC bacilli and progressive worsening of chest radiographic findings until death. We have reported that the measurements of anti-MBGL antibody titers helped assess refractory MAC-PD in this study. Furthermore, the predictions of treatment outcome and mortality become more accurate by using the anti-MBGL antibody in addition to clinical poor prognostic characteristics, which were older age, lower body mass index, the positive results of a smear test for acid-fast bacteria (AFB), and presence of cavitary disease.
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影响因子：
24.3
作者：
Jhun, Byung Woo;Moon, Seong Mi;Koh, Won-Jung
通讯作者：
Koh, Won-Jung
影响因子：
4.3
作者：
Furuuchi, Koji;Morimoto, Kozo;Sasaki, Yuka
通讯作者：
Sasaki, Yuka
影响因子：
3.7
作者：
Kobashi, Yoshihiro;Matsushima, Toshiharu
通讯作者：
Matsushima, Toshiharu
影响因子：
11.8
作者：
Kitada, S;Maekura, R;Kobayashi, K
通讯作者：
Kobayashi, K
DOI：
10.1164/rccm.200705-771oc
发表时间：
2008-04-01
影响因子：
24.7
作者：
Kitada, Seigo;Kobayashi, Kazuo;Maekura, Ryoji
通讯作者：
Maekura, Ryoji