Abstract
BackgroundThe risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known. We hypothesized that low serum estradiol (E2) levels are related to MAC-LD as most patients with MAC-LD are postmenopausal women.MethodsThis cross-sectional study compared patients with MAC-LD and healthy controls. Study subjects were postmenopausal women aged 65 years or younger. Serum testosterone, dehydroepiandrosterone sulfate (DHEA-S), and E2 levels were measured and categorized as high or low based on median levels. We performed multivariate analysis, receiver operating characteristic (ROC) curve analysis, and age- and body mass index (BMI)-matched subgroup analysis to evaluate the association between low serum E2 levels and MAC-LD.Additionally, using blood samples obtained for other clinical studies, the levels of sex steroid hormones were compared between age- and BMI-matched MAC-LD and bronchiectasis female patients without non-tuberculosis mycobacterial infections (non-NTM BE).ResultsForty-two patients with MAC-LD and 91 healthy controls were included. The median E2 (2.20 pg/mL vs. 15.0 pg/mL, p < 0.001), testosterone (0.230 ng/L vs. 0.250 ng/L, p = 0.005), and DHEA-S (82.5 μg/dL vs. 114.0 μg/dL, p < 0.001) levels were lower in the MAC-LD group than in the control group. Multivariate analysis revealed that low serum E2 (adjusted odds ratio = 34.62, 95% confidence interval = 6.02–199.14) was independently related to MAC-LD, whereas low DHEA-S and testosterone were not. ROC analysis illustrated a strong relationship between low serum E2 levels and MAC-LD (area under the curve = 0.947, 95% confidence interval = 0.899–0.995). Even the age- and BMI-matched subgroup analysis of 17 MAC-LD patients and 17 healthy controls showed lower serum E2 in MAC-LD patients than in healthy controls. Additionally, serum E2 levels of 20 MAC-LD patients were lower than plasma E2 levels of 11 matched non-NTM BE patients (1.79 pg/mL vs. 11.0 pg/mL, p < 0.001).ConclusionsLow serum E2 levels were strongly related to MAC-LD in postmenopausal women.
Highlights
The risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known
In the analyses comparing MAC-LD patients with healthy controls, to assess factors independently associated with MAC-LD, we performed logistic regression analyses via the simultaneous method
The patients with MAC-LD were significantly older than the healthy controls (61 years vs. 56 years, p < 0.001), whereas body mass index (BMI) was significantly lower in the MAC-LD group (19.14 kg/m2 vs. 22.18 kg/m2, p < 0.001)
Summary
The risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known. We hypothesized that low serum estradiol (E2) levels are related to MAC-LD as most patients with MAC-LD are postmenopausal women. Mycobacterium avium complex (MAC) lung disease (MAC-LD) accounts for approximately 80 and 90% of all cases of pulmonary NTM infection in the United States and Japan, respectively, MAC-LD is a chronic and refractory respiratory infection with unclear pathogenesis and unknown risk factors. A number of epidemiological studies have revealed that patients with MAC-LD are predominantly elderly and postmenopausal women [4, 5]. On the basis of these findings, decreases in sex hormone levels, especially estradiol (E2), after menopause might represent a risk factor for MACLD.
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