Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study
Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study
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DOI：
10.1183/13993003.00798-2019
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发表时间：
2020-01-01
影响因子：
24.3
通讯作者：
Koh, Won-Jung
中科院分区：
文献类型：
--
作者：
Jhun, Byung Woo;Moon, Seong Mi;Koh, Won-Jung
关于非结核分枝杆菌肺病（NTM-PD）患者的预后因素的数据有限。我们研究了与NTM-PD患者长期死亡率相关的预后因素，调整了包括病原微生物和放射学形式在内的单个混杂因素后，共纳入了1445例1997年7月至2013年12月期间新诊断的未经治疗的NTM-PD患者。病原菌为鸟分枝杆菌（Mycobacterium avium，n=655）、M. intracellulare（n=487）、M. dumessus（n=129）和M.（n=174）。在调整人口学、放射学和病因学数据后，使用多变量考克斯模型分析与NTM-PD患者死亡相关的因素，NTM-PD患者的总体5年、10年和15年累积死亡率分别为12.4%、24.0%和36.4%。多因素分析显示，以下因素与NTM-PD患者的死亡率显著相关：高龄、男性、低体重指数、慢性肺曲霉病、肺或肺外恶性肿瘤、慢性心脏或肝脏疾病和红细胞沉降率。病原微生物也与死亡率显著相关：M。细胞内感染的校正风险比（aHR）为1.40，95% CI 1.03-1.91;黑胸鼠的aHR为2.19，95% CI为1.36-3.51; M.与M相比，Eschliense的aHR为0.99，95%CI为0.61-1.64。avium死亡率也与NTM-PD的空洞结节性支气管扩张型的放射学形式显著相关（aHR 1.70，95% CI 1.12-2.59）和纤维空洞型（aHR 2.12，95%CI 1.57-3.08）。NTM-PD患者的长期死亡率与病原学NTM微生物显著相关，空洞性疾病和某些人口特征。
Limited data are available regarding the prognostic factors for patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the prognostic factors associated with longterm mortality in NTM-PD patients after adjusting for individual confounders, including aetiological organism and radiological form.A total of 1445 patients with treatment-naive NTM-PD who were newly diagnosed between July 1997 and December 2013 were included. The aetiological organisms were as follows: Mycobacterium avium (n=655), M. intracellulare (n=487), M. abscessus (n=129) and M. massiliense (n=174). The factors associated with mortality in NTM-PD patients were analysed using a multivariable Cox model after adjusting for demographic, radiological and aetiological data.The overall 5-, 10-and 15-year cumulative mortality rates for the NTM-PD patients were 12.4%, 24.0% and 36.4%, respectively. On multivariable analysis, the following factors were significantly associated with mortality in NTM-PD patients: old age, male sex, low body mass index, chronic pulmonary aspergillosis, pulmonary or extrapulmonary malignancy, chronic heart or liver disease and erythrocyte sedimentation rate. The aetiological organism was also significantly associated with mortality: M. intracellulare had an adjusted hazard ratio (aHR) of 1.40, 95% CI 1.03-1.91; M. abscessus had an aHR of 2.19, 95% CI 1.36-3.51; and M. massiliense had an aHR of 0.99, 95% CI 0.61-1.64, compared to M. avium. Mortality was also significantly associated with the radiological form of NTM-PD for the cavitary nodular bronchiectatic form (aHR 1.70, 95% CI 1.12-2.59) and the fibrocavitary form (aHR 2.12, 95% CI 1.57-3.08), compared to the non-cavitary nodular bronchiectatic form.Long-term mortality in patients with NTM-PD was significantly associated with the aetiological NTM organism, cavitary disease and certain demographic characteristics.