Hayoung Choi, Chloe Hughes, Zsofia Eke, Morven Shuttleworth, Michal Shteinberg, Eva Polverino, Pieter C Goeminne, Tobias Welte, Francesco Blasi, Amelia Shoemark, Merete B Long, Stefano Aliberti, Charles S Haworth, Felix C Ringshausen, Michael R Loebinger, Natalie Lorent, James D Chalmers
{"title":"用于筛查支气管扩张症非结核分枝杆菌肺病的血清抗甘肽多脂核 IgA 抗体检测的临床疗效：欧洲多中心队列研究》。","authors":"Hayoung Choi, Chloe Hughes, Zsofia Eke, Morven Shuttleworth, Michal Shteinberg, Eva Polverino, Pieter C Goeminne, Tobias Welte, Francesco Blasi, Amelia Shoemark, Merete B Long, Stefano Aliberti, Charles S Haworth, Felix C Ringshausen, Michael R Loebinger, Natalie Lorent, James D Chalmers","doi":"10.1016/j.chest.2024.10.029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Serum anti-glycopeptidolipid (GPL) core immunoglobuin A (IgA) antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. Cross-reactivity with other non-tuberculous mycobacteria (NTM), including M. abscessus, indicates that it may have a role as a broader screening test for NTM pulmonary disease (NTM-PD). NTM-PD is believed to be underdiagnosed in patients with bronchiectasis.</p><p><strong>Research question: </strong>Can the serum anti-GPL core IgA antibody test be used to screen for NTM-PD in bronchiectasis?</p><p><strong>Study design and methods: </strong>Patients from the prospective European Bronchiectasis Registry (EMBARC-BRIDGE; NCT03791086) were enrolled. Patients from the United Kingdom, Italy, Spain, Belgium, the Netherlands, and Germany were included. A control cohort of patients without any underlying lung disease was also recruited. The levels of serum IgA antibodies against the GPL core were measured using an enzyme immunoassay kit, and receiver operating characteristics curve analysis was conducted to evaluate the accuracy of the antibody level in screening for NTM-PD.</p><p><strong>Results: </strong>282 patients were enrolled (151 [53.6%] female, median age 68 years). Median (quartile 1-3) anti-GPL-core IgA antibody levels were 0.2 (0.1-0.3) U/mL in patients without NTM isolation and NTM-PD (n=238), 0.3 (0.2-0.4) U/mL in NTM isolation that were incompatible with the diagnosis of NTM-PD (n=18) and 1.5 (0.4-6.2) U/mL in NTM-PD (n=26) (P=0.0001). Antibody levels showed excellent accuracy in identifying patients with NTM-PD (area under the curve 0.886, 95% CI 0.800-0.973) in bronchiectasis cohort and also showed excellent discrimination of patients with NTM-PD from those with NTM isolation who did not meet the diagnostic criteria for NTM-PD (0.816, 95% CI 0.687-0.945).</p><p><strong>Interpretation: </strong>The anti-GPL-core IgA antibody demonstrated excellent efficacy in screening for NTM-PD in a large bronchiectasis cohort.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Efficacy of Serum Anti-glycopeptidolipid-core IgA Antibody Test for Screening Nontuberculous Mycobacterial Pulmonary Disease in Bronchiectasis: A European Multicenter Cohort Study.\",\"authors\":\"Hayoung Choi, Chloe Hughes, Zsofia Eke, Morven Shuttleworth, Michal Shteinberg, Eva Polverino, Pieter C Goeminne, Tobias Welte, Francesco Blasi, Amelia Shoemark, Merete B Long, Stefano Aliberti, Charles S Haworth, Felix C Ringshausen, Michael R Loebinger, Natalie Lorent, James D Chalmers\",\"doi\":\"10.1016/j.chest.2024.10.029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Serum anti-glycopeptidolipid (GPL) core immunoglobuin A (IgA) antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. 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引用次数: 0
摘要
背景：血清抗甘肽多脂（GPL）核心免疫球蛋白A（IgA）抗体检测已被提议作为复合分枝杆菌肺部疾病的诊断工具。它与包括脓肿分枝杆菌在内的其他非结核分枝杆菌（NTM）的交叉反应表明，它可以作为更广泛的非结核分枝杆菌肺病（NTM-PD）筛查试验。据信，支气管扩张症患者的 NTM-PD 诊断不足：研究问题：血清抗 GPL 核心 IgA 抗体检测能否用于筛查支气管扩张症患者的 NTM-PD？前瞻性欧洲支气管扩张注册（EMBARC-BRIDGE；NCT03791086）中的患者被纳入研究。研究对象包括来自英国、意大利、西班牙、比利时、荷兰和德国的患者。同时还招募了没有任何潜在肺部疾病的对照组患者。使用酶联免疫测定试剂盒测定了血清中针对 GPL 核心的 IgA 抗体水平，并进行了接收器操作特征曲线分析，以评估抗体水平在筛查 NTM-PD 中的准确性。在未分离出 NTM 和 NTM-PD 的患者中，抗 GPL 核心 IgA 抗体水平中位数（1-3 分位）为 0.2 (0.1-0.3) U/mL（n=238）；在分离出 NTM 但不符合 NTM-PD 诊断的患者中，抗 GPL 核心 IgA 抗体水平中位数为 0.3 (0.2-0.4) U/mL（n=18）；在 NTM-PD 患者中，抗 GPL 核心 IgA 抗体水平中位数为 1.5 (0.4-6.2) U/mL（n=26）（P=0.0001）。在支气管扩张症队列中，抗体水平在鉴别 NTM-PD 患者方面显示出极佳的准确性（曲线下面积 0.886，95% CI 0.800-0.973），同时还显示出对 NTM-PD 患者与不符合 NTM-PD 诊断标准的 NTM 分离患者的极佳区分度（0.816，95% CI 0.687-0.945）：抗 GPL 核心 IgA 抗体在大型支气管扩张症队列中筛查 NTM-PD 的效果非常好。
Clinical Efficacy of Serum Anti-glycopeptidolipid-core IgA Antibody Test for Screening Nontuberculous Mycobacterial Pulmonary Disease in Bronchiectasis: A European Multicenter Cohort Study.
Background: Serum anti-glycopeptidolipid (GPL) core immunoglobuin A (IgA) antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. Cross-reactivity with other non-tuberculous mycobacteria (NTM), including M. abscessus, indicates that it may have a role as a broader screening test for NTM pulmonary disease (NTM-PD). NTM-PD is believed to be underdiagnosed in patients with bronchiectasis.
Research question: Can the serum anti-GPL core IgA antibody test be used to screen for NTM-PD in bronchiectasis?
Study design and methods: Patients from the prospective European Bronchiectasis Registry (EMBARC-BRIDGE; NCT03791086) were enrolled. Patients from the United Kingdom, Italy, Spain, Belgium, the Netherlands, and Germany were included. A control cohort of patients without any underlying lung disease was also recruited. The levels of serum IgA antibodies against the GPL core were measured using an enzyme immunoassay kit, and receiver operating characteristics curve analysis was conducted to evaluate the accuracy of the antibody level in screening for NTM-PD.
Results: 282 patients were enrolled (151 [53.6%] female, median age 68 years). Median (quartile 1-3) anti-GPL-core IgA antibody levels were 0.2 (0.1-0.3) U/mL in patients without NTM isolation and NTM-PD (n=238), 0.3 (0.2-0.4) U/mL in NTM isolation that were incompatible with the diagnosis of NTM-PD (n=18) and 1.5 (0.4-6.2) U/mL in NTM-PD (n=26) (P=0.0001). Antibody levels showed excellent accuracy in identifying patients with NTM-PD (area under the curve 0.886, 95% CI 0.800-0.973) in bronchiectasis cohort and also showed excellent discrimination of patients with NTM-PD from those with NTM isolation who did not meet the diagnostic criteria for NTM-PD (0.816, 95% CI 0.687-0.945).
Interpretation: The anti-GPL-core IgA antibody demonstrated excellent efficacy in screening for NTM-PD in a large bronchiectasis cohort.
期刊介绍：
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