Background

Although recent studies have identified anti-glycopeptidolipid (GPL)-core IgA antibodies as a serodiagnostic test for Mycobacterium avium complex lung disease (MAC-LD), this test shows insufficient sensitivity. This study aimed to determine the clinical utility of these antibodies in assessing disease progression and the clinical characteristics of MAC-LD patients with negative antibody results.

Methods

We retrospectively reviewed the medical records of consecutive newly diagnosed, untreated MAC-LD patients in two referral hospitals. We evaluated the association of anti-GPL-core IgA antibody results with disease progression requiring treatment and the factors associated with negative antibody results.

Results

In total, 229 patients (161 females; median age, 71 years; 185 with nodular/bronchiectatic disease phenotype; 69 with cavitary lesions) were enrolled; 146 patients (64%) were anti-GPL-core IgA antibody-positive. Radiological severity scores were associated with anti-GPL-core IgA antibody titers. During the median 364-day follow-up, 114 patients (49.8%) required treatment. Multivariate Cox proportional hazards analysis showed that positive anti-GPL-core IgA antibody results, a younger age, the absence of malignancy, and the presence of cavitary lesions were associated with disease progression requiring treatment. Multivariate logistic analysis revealed that significant factors related to the negative antibody results included underlying pulmonary disease, lower radiological scores, chronic sinusitis, and macrolide monotherapy.

Conclusion

In addition to cavitary lesions, anti-GPL-core IgA antibody positivity was associated with disease progression requiring treatment. Physicians should carefully use anti-GPL-core IgA antibody results for the diagnosis of patients with underlying pulmonary disease, chronic sinusitis, macrolide monotherapy, and lower radiological severity.

中文翻译：

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抗糖肽脂质核心IgA抗体在新诊断为鸟分枝杆菌复杂性肺病的患者中的临床意义。

背景

尽管最近的研究已将抗糖肽脂质（GPL）核心IgA抗体鉴定为鸟分枝杆菌复杂性肺病（MAC-LD）的血清诊断测试，但该测试显示灵敏度不足。这项研究旨在确定这些抗体在评估疾病进展和抗体阴性的MAC-LD患者临床特征方面的临床效用。

方法

我们回顾性回顾了两家转诊医院连续新诊断，未经治疗的MAC-LD患者的病历。我们评估了抗GPL核心IgA抗体结果与需要治疗的疾病进展以及与阴性抗体结果相关的因素之间的关联。

结果

总共纳入了229例患者（161名女性；中位年龄71岁； 185例结节性/支气管疾病表型； 69例有空洞病变）。146例患者（64％）呈抗GPL核心IgA抗体阳性。放射学严重程度评分与抗GPL核心IgA抗体滴度相关。在364天的中位随访期间，有114名患者（49.8％）需要治疗。多元Cox比例风险分析表明，抗GPL核心IgA抗体阳性，年龄年轻，恶性肿瘤的缺乏和空洞病变的存在与需要治疗的疾病进展有关。多元逻辑分析表明，与抗体阴性结果相关的重要因素包括潜在的肺部疾病，较低的放射学评分，慢性鼻窦炎和大环内酯类单一疗法。

结论

除空洞病变外，抗GPL核心IgA抗体的阳性与需要治疗的疾病进展有关。医师应谨慎使用抗GPL核心IgA抗体的结果诊断潜在的肺部疾病，慢性鼻窦炎，大环内酯类单一疗法和较低的放射学严重性。