背景：非结核性分枝杆菌肺病（NTM-PD）被广泛诊断不足，和某些患者群体，比如那些有潜在呼吸道疾病的人，患这种疾病的风险增加。了解处于危险中的患者对于迅速进行测试和诊断以及适当的管理以防止疾病进展至关重要。
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。
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is widely underdiagnosed, and certain patient groups, such as those with underlying respiratory diseases, are at increased risk of developing the disease. Understanding patients at risk is essential to allow for prompt testing and diagnosis and appropriate management to prevent disease progression.
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.
