Low serum estradiol levels are related to Mycobacterium avium complex lung disease: a cross-sectional study

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 1055
• Main Authors: Uwamino, Yoshifumi, Nishimura, Tomoyasu, Sato, Yasunori, Tamizu, Eiko, Asakura, Takanori, Uno, Shunsuke, Mori, Masaaki, Fujiwara, Hiroshi, Ishii, Makoto, Kawabe, Hiroshi, Murata, Mitsuru, Hasegawa, Naoki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.12.2019; BioMed Central; BMC
• Subjects: 17β-Estradiol; Age; Antigens; Bacterial infections; Body mass; Body Mass Index; Body size; Bronchiectasis; Bronchiectasis - blood; Chronic illnesses; Clinical trials; Comparative analysis; Confidence intervals; Cross-Sectional Studies; Dehydroepiandrosterone; Dehydroepiandrosterone sulfate; Dehydroepiandrosterone Sulfate - blood; Estradiol; Estradiol - blood; Estrogens; Female; Health aspects; HIV; Hormones; Hospitals; Human immunodeficiency virus; Humans; Immunoassay; Infections; Infectious diseases; Japan; Lung diseases; Lung Diseases - blood; Lung Diseases - microbiology; Medical research; Menopause; Menstruation; Middle age; Middle Aged; Multivariate Analysis; Mycobacterium avium; Mycobacterium avium complex; Mycobacterium avium Complex - isolation & purification; Mycobacterium avium-intracellulare Infection - microbiology; Older people; Patients; Phenols (Class of compounds); Population; Post-menopause; Postmenopausal women; Postmenopause - physiology; Respiratory tract diseases; Risk analysis; Risk Factors; ROC Curve; Sex hormones; Steroid hormones; Steroids; Subgroups; Sulfates; Tertiary Care Centers; Testosterone; Testosterone - blood; Tuberculosis; Women's health; Womens health; Japan; Taiwan; United States > US; Estradiol; Mycobacterium avium complex; Postmenopausal women
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-4668-x

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. This 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). Forty-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). Low serum E2 levels were strongly related to MAC-LD in postmenopausal women.