固体器官移植接受者和普通人群的非结核性菌根性疾病
Seyed M Hosseini-Moghaddam1,2,3, Daniel Fridman1, Samantha S M Drover1
1ICES, Toronto, Ontario, Canada.
JAMA network open
|September 12, 2025
概括
固体器官移植接受者 (SOTRs) 面临的非结核性真菌菌病 (NTM-D) 的风险明显更高,这与死亡率的增加有关. 肺移植接受者特别脆弱,这强调了有针对性的预防和查策略的必要性.
科学领域:
- 移植免疫学 移植免疫学
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 非结核性真菌菌病 (NTM-D) 对实体器官移植受体 (SOTR) 构成重大威胁,单中心研究表明死亡率较高,特别是在慢性肺病等共存疾病中.
- 基于人口的大规模证据对于准确量化NTM-D风险及其对SOTRs的死亡影响至关重要.
研究的目的:
- 为了比较SOTR中NTM-D的发病率与普通人群的发病率,按移植类型分层 (肺与非肺).
- 确定NTM-D诊断是否独立地与SOTRs中所有原因死亡率的增加有关.
主要方法:
- 在加拿大安大略省 (2002-2018) 进行的一项基于人口的队列研究,将1:10 SOTR与一般人口对照进行了匹配.
- 通过从临床样本中分离的真菌细菌来定义NTM-D;在1年和随访结束 (2021) 评估所有原因的死亡率.
- 考克斯的比例危险模型被用来分析NTM-D和死亡率的风险.
主要成果:
- 该研究包括12,564个SOTR和125,611个对照. 与对照组相比,SOTRs的NTM-D发病率 (2.92%) 显著更高 (0.10%).
- 与对照组相比,肺移植接受者表现出最高的风险 (aHR,177.34),其次是其他SOTR (aHR,8.89),与对照组相比.
- 特别是来自Mycobacterium avium复合体 (MAC) 和快速生长的真菌菌 (RGM) 的NTM-D与肺部和非肺部SOTRs的长期死亡率增加有关.
结论:
- 固体器官移植,特别是肺移植,显著增加患NTM-D的风险.
- NTM-D是SOTR死亡率增加的独立风险因素,强调需要主动查和预防措施.
- 这些发现支持在SOTR群体中开发针对NTM-D的有针对性的监测和管理策略.
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