支气管扩张患者的高NTM感染率与吸入糖皮质激素有关吗？| 引经据典[14] · 协和呼吸

本/期/解/读

吸入糖皮质激素的使用与非结核分枝杆菌肺感染的相关性

Association between Inhaled Corticosteroid Use and Pulmonary Nontuberculous

Mycobacterial Infection

关键词

非结核分枝杆菌，支气管扩张，吸入激素，COPD，感染

作者：

Vincent X Liu, et. al

翻译：

北京协和医院呼吸内科  孙宇新  黄慧

文献来源：

Ann Am Thorac Soc. 2018 Sep 14.

DOI:

10.1513/AnnalsATS.201804-245OC

  背景及目的  

非结核分枝杆菌（NTM）的发病率逐年升高，本研究拟探索因气道疾病使用吸入糖皮质激素（ICS）与NTM感染之间的相关性。

  方   法  

本病例对照研究纳入2000-2010年间北加州的慢性气道疾病患者，根据呼吸道标本分支杆菌感染的结果分为感染NTM组（病例组）与未感染NTM组（对照组）。统计NTM感染半年内的ICS总量、气道疾病的伴随用药、就医情况，并按感染组:对照组=1:10入组，并用logistic回归方法来推测ICS的累积量及疗程与NTM感染之间的相关性。

  结    果  

共纳入248例NTM感染者，发病率约16.4/10000。发生NTM感染的中位时间是1217天（起始时间定义为第三张处方的日期），相对于对照组，NTM病例组更多使用合并用药，包括系统性糖皮质激素；更多地就医率（包括急诊、住院等）。入组前120d-2y期间使用ICS都可增加NTM感染风险：入组前2年内ICS的使用后NTM感染的OR为2.51（95％CI：1.40-4.49；p＜0.01）；且随着ICS累积量的增加，NTM感染的风险增高。

  结    论  

吸入糖皮质激素，尤其是随着吸入激素累积剂量的增加，使得肺NTM感染的风险增加。

原文摘要

Rationale

Nontuberculous mycobacterial (NTM) pulmonary disease prevalence is increasing.

Objectives

To determine the association between the use of inhaled corticosteroids and the likelihood of NTM pulmonary infection among individuals with treated airways disease. Methods: We conducted a case-control study of airway disease subjects with and without NTM pulmonary infection (based on mycobacterial respiratory cultures) between 2000 and 2010 in Northern California. We quantified the use of inhaled corticosteroids, other airways disease medications, and healthcare utilization within six months of NTM pulmonary infection identification. We used 1:10 case:control matching and conditional logistic regression to evaluate the association between the duration and cumulative dosage of ICS use and NTM pulmonary infection.

Results

We identified 248 cases with NTM pulmonary infection with an estimated rate of 16.4 cases per 10,000 airway disease-treated subjects. The median interval between treated airway disease cohort entry (defined as date of patient filling the third airways disease treatment prescription) and NTM case identification was 1,217 days. Compared with controls, subjects with NTM pulmonary infection were more likely to use airway disease medications including systemic steroids; they were also more likely to utilize healthcare. Any inhaled corticosteroids use between 120 days and two years prior to cohort entry was associated with substantially increased odds of NTM infection. For example, the adjusted odds ratio for NTM infection among inhaled corticosteroids users in a two year interval was 2.51 (95% confidence interval: 1.40-4.49; p<0.01). Increasing cumulative inhaled corticosteroids dose was also associated with greater odds of NTM infection.

Conclusions

Inhaled corticosteroids use, and particularly high dose inhaled corticosteroids use,was associated with an increased risk of NTM pulmonary infection

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作者介绍

孙宇新

北京协和医院呼吸内科硕士在读

北京协和医院呼吸内科2018级硕士研究生，所在课题组主要从事间质性肺病方向的临床和基础研究。

往期经典

文字来源：孙宇新   黄 慧

栏目负责：黄    慧

版面编辑：陈珂琪

图片来源：部分来源于网络，如有侵权，请联系删除

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