What are the risk factors for NTM-PD that should prompt a physician to consider NTM testing and diagnosis?
Electronic searches of PubMed and EMBASE were conducted in July 2021 for the period 2011-2021. Inclusion criteria were studies of patients with NTM-PD with associated risk factors. Data were extracted and assessed using the Newcastle-Ottawa Scale. Data analysis was conducted using the R-based \"meta\" package. Only studies that reported association outcomes for cases with NTM-PD compared with control participants (healthy populations or participants without NTM-PD) were considered for the meta-analysis.
Of the 9,530 searched publications, 99 met the criteria for the study. Of these, 24 formally reported an association between possible risk factors and the presence of NTM-PD against a control population and were included in the meta-analysis. Comorbid respiratory disease was associated with a significant increase in the OR for NTM-PD (bronchiectasis [OR, 21.43; 95% CI, 5.90-77.82], history of TB [OR, 12.69; 95% CI, 2.39-67.26], interstitial lung disease [OR, 6.39; 95% CI, 2.65-15.37], COPD [OR, 6.63; 95% CI, 4.57-9.63], and asthma [OR, 4.15; 95% CI, 2.81-6.14]). Other factors noted to be associated with an increased risk of NTM-PD were the use of inhaled corticosteroids (OR 4.46; 95% CI, 2.13-9.35), solid tumors (OR, 4.66; 95% CI, 1.04-20.94) and the presence of pneumonia (OR, 5.54; 95% CI, 2.72-11.26).
The greatest risk for NTM-PD is conferred by comorbid respiratory diseases such as bronchiectasis. These findings could help with identification of patient populations at risk for NTM-PD to drive prompt testing and appropriate initiation of therapy.
目的:NTM-PD的危险因素应促使医生考虑NTM测试和诊断?
方法:在2021年7月对PubMed和EMBASE进行了电子检索,为期2011-2021年。纳入标准是对具有相关危险因素的NTM-PD患者的研究。提取数据并使用纽卡斯尔-渥太华量表进行评估。使用基于R的“元”包进行数据分析。荟萃分析仅考虑报告NTM-PD病例与对照参与者(健康人群或无NTM-PD的参与者)相关结果的研究。
结果:在搜索的9,530个出版物中,99符合研究标准。其中,24正式报告了可能的危险因素与对照人群中NTM-PD的存在之间的关联,并包括在荟萃分析中。合并症呼吸系统疾病与NTM-PD的OR显着增加有关(支气管扩张[OR,21.43;95%CI,5.90-77.82],结核病史[或,12.69;95%CI,2.39-67.26],间质性肺病[或,6.39;95%CI,2.65-15.37],COPD[或,6.63;95%CI,4.57-9.63],和哮喘[或,4.15;95%CI,2.81-6.14])。注意到与NTM-PD风险增加相关的其他因素是吸入性皮质类固醇的使用(OR4.46;95%CI,2.13-9.35),实体瘤(OR,4.66;95%CI,1.04-20.94)和肺炎的存在(OR,5.54;95%CI,2.72-11.26)。
结论:NTM-PD的最大风险是并发呼吸系统疾病,如支气管扩张。这些发现可以帮助识别有NTM-PD风险的患者人群,以推动及时测试和适当的治疗开始。