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Abstract：
OBJECTIVE: Mycobacterium abscessus complex (MABC) commonly causes lung disease (LD) and has a high treatment failure rate of around 50%. In this study, our objective is to investigate specific CT patterns for predicting treatment prognosis and monitoring treatment response, thus providing valuable insights for clinical physicians in the management of MABC-LD treatment.
METHODS: We retrospectively assessed 34 patients with MABC-LD treated between January 2015 and December 2020. CT scores for bronchiectasis, cellular bronchiolitis, consolidation, cavities, and nodules were measured at initiation and after treatment. The ability of the CT scores to predict treatment outcomes was analyzed in logistic regression analyses.
RESULTS: The CT scoring system had excellent inter-reader agreement (all intraclass correlation coefficients, > 0.82). The treatment failure (TF) group (17/34; 50%) had higher cavitation diameter (p = 0.049) and extension (p = 0.041) at initial CT and higher cavitation diameter (p = 0.049) and extension (p =0 .045), consolidation (p = 0.022), and total (p = 0.013) scores at follow-up CT than the treatment success (TS) group. The changes of total score and consolidation score (p = 0.049 and 0.024, respectively) increased in the TF group more than the TS group between the initial and follow-up CT. Multivariable logistic regression analysis showed initial cavitation extension, follow-up consolidation extension, and change in consolidation extension (adjusted odds ratio: 2.512, 2.495, and 9.094, respectively, per 1-point increase; all p < 0.05) were significant predictors of treatment failure.
CONCLUSIONS: A high pre-treatment cavitation extension score and an increase in the consolidation extension score during treatment on CT could be alarm signs of treatment failure requiring tailor the treatment of MABC-LD carefully.
METHODS: We retrospectively assessed 34 patients with MABC-LD treated between January 2015 and December 2020. CT scores for bronchiectasis, cellular bronchiolitis, consolidation, cavities, and nodules were measured at initiation and after treatment. The ability of the CT scores to predict treatment outcomes was analyzed in logistic regression analyses.
RESULTS: The CT scoring system had excellent inter-reader agreement (all intraclass correlation coefficients, > 0.82). The treatment failure (TF) group (17/34; 50%) had higher cavitation diameter (p = 0.049) and extension (p = 0.041) at initial CT and higher cavitation diameter (p = 0.049) and extension (p =0 .045), consolidation (p = 0.022), and total (p = 0.013) scores at follow-up CT than the treatment success (TS) group. The changes of total score and consolidation score (p = 0.049 and 0.024, respectively) increased in the TF group more than the TS group between the initial and follow-up CT. Multivariable logistic regression analysis showed initial cavitation extension, follow-up consolidation extension, and change in consolidation extension (adjusted odds ratio: 2.512, 2.495, and 9.094, respectively, per 1-point increase; all p < 0.05) were significant predictors of treatment failure.
CONCLUSIONS: A high pre-treatment cavitation extension score and an increase in the consolidation extension score during treatment on CT could be alarm signs of treatment failure requiring tailor the treatment of MABC-LD carefully.
摘要：
目的：脓肿分枝杆菌复合体（MABC）通常会引起肺部疾病（LD），治疗失败率高，约为50％。在这项研究中,我们的目标是研究特定的CT模式，以预测治疗预后和监测治疗反应，从而为临床医师管理MABC-LD治疗提供有价值的见解。
方法：我们回顾性评估了2015年1月至2020年12月接受MABC-LD治疗的34例患者。支气管扩张的CT评分,细胞细支气管炎,合并，空腔,在治疗开始时和治疗后测量结节。在逻辑回归分析中分析了CT评分预测治疗结果的能力。
结果：CT评分系统具有出色的读者间一致性（所有组内相关系数，>0.82）。治疗失败（TF）组（17/34;50％）在初始CT时具有较高的空化直径（p=0.049）和延伸（p=0.041），并且具有较高的空化直径（p=0.049）和延伸（p=0.045），固结(p=0.022)，和总评分（p=0.013）在随访CT比治疗成功（TS）组。在初始和随访CT之间，TF组的总分和巩固评分的变化（分别为p=0.049和0.024）比TS组增加更多。多变量logistic回归分析显示初始空化扩展，后续合并扩展，和合并扩展的变化(调整后的赔率比分别为2.512、2.495和9.094，每增加1分；所有p<0.05）是治疗失败的显著预测因素。
结论：在CT上治疗期间，高的治疗前空化扩展评分和巩固扩展评分的增加可能是治疗失败的警报迹象，需要仔细调整MABC-LD的治疗。
方法：我们回顾性评估了2015年1月至2020年12月接受MABC-LD治疗的34例患者。支气管扩张的CT评分,细胞细支气管炎,合并，空腔,在治疗开始时和治疗后测量结节。在逻辑回归分析中分析了CT评分预测治疗结果的能力。
结果：CT评分系统具有出色的读者间一致性（所有组内相关系数，>0.82）。治疗失败（TF）组（17/34;50％）在初始CT时具有较高的空化直径（p=0.049）和延伸（p=0.041），并且具有较高的空化直径（p=0.049）和延伸（p=0.045），固结(p=0.022)，和总评分（p=0.013）在随访CT比治疗成功（TS）组。在初始和随访CT之间，TF组的总分和巩固评分的变化（分别为p=0.049和0.024）比TS组增加更多。多变量logistic回归分析显示初始空化扩展，后续合并扩展，和合并扩展的变化(调整后的赔率比分别为2.512、2.495和9.094，每增加1分；所有p<0.05）是治疗失败的显著预测因素。
结论：在CT上治疗期间，高的治疗前空化扩展评分和巩固扩展评分的增加可能是治疗失败的警报迹象，需要仔细调整MABC-LD的治疗。
