Clinical symptoms and survival in non-smoking and smoking HIV-negative patients with non-tuberculous mycobacterial isolation
Clinical symptoms and survival in non-smoking and smoking HIV-negative patients with non-tuberculous mycobacterial isolation
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DOI：
10.3109/00365548.2010.535558
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发表时间：
2011-03-01
影响因子：
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通讯作者：
Jarvinen, Asko
中科院分区：
文献类型：
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作者：
Kotilainen, Hannele;Valtonen, Ville;Jarvinen, Asko
背景：非结核分枝杆菌(NTM)可引起吸烟相关慢性肺部疾病患者和不吸烟的健康老年妇女的感染。我们分析了NTM培养结果患者的临床症状、基础疾病和死亡率，特别强调吸烟状况。方法：对1990-1998年间连续120例HIV阴性、NTM隔离的成人患者进行跟踪调查，从他们的病历中检索数据至少4年，直到2006年6月8日。根据吸烟情况分析其临床表现和预后。结果：在这项研究中，42%的患者从未吸烟。女性占不吸烟者的72%，但只占吸烟者的30%(p<；0.001)。在非吸烟者和吸烟者中，鸟分枝杆菌复合体占分离株的72%和41%(p=0.001)。此外，28%的非吸烟者和19%的吸烟者以前没有肺部疾病(p=0.223)。在所有患者中，近一半(48%)在分离NTM前一年内开始出现NTM感染症状。吸烟者比不吸烟者有更高的死亡风险(风险比1.64，p=0.049)，尽管在调整潜在疾病后没有发现这一点。82%的非吸烟者和59%的吸烟者没有发现致命的潜在疾病(p<；0.01)。结论：携带NTM分离株的非吸烟者既往肺部疾病较少，但MAC和支气管扩张的发生率较高。从症状到分离NTM的时间比以前报道的要短。
Background: Non-tuberculous mycobacteria (NTM) cause infections in patients with smoking-related chronic lung diseases and also in non-smoking healthy elderly women. We analyzed the clinical symptoms, underlying diseases and mortality in patients with NTM culture findings, with special emphasis on smoking status. Methods: A total of 120 consecutive adult HIV-negative patients with NTM isolation were followed between 1990 and 1998 by retrieving data from their medical records for a period of at least 4 y, until 8 June 2006. Their clinical pictures and outcomes were analysed according to smoking status. Results: In this study, 42% of the patients had never smoked. Females accounted for 72% of non-smokers, but only 30% of smokers (p < 0.001). Mycobacterium avium complex (MAC) accounted for 72% of all isolates in nonsmokers and 41% in smokers (p = 0.001). Furthermore, 28% of non-smokers and 19% of smokers had no previous pulmonary diseases (p = 0.223). In nearly half of all patients (48%), symptoms of NTM infection started within a year prior to NTM isolation. Smokers had a higher risk of mortality compared to non-smokers (hazard ratio 1.64, p = 0.049), though this was not found after adjusting for underlying diseases. No fatal underlying diseases were found for 82% of non-smokers and 59% of smokers (p < 0.01). Conclusions: Non-smokers with NTM isolates had fewer previous lung diseases but had a higher incidence of MAC and bronchiectasis. Time from symptoms to NTM isolation was shorter than previously reported.