A study on pulmonary tuberculosis retreatment cases

OBJECTIVE: To investigate the factors leading to the retreatment for tuberculosis. MATERIALS: Forty-seven retreatment cases with pulmonary tuberculosis, who were discharged from the National Chiba Higashi Hospital from 2000 to 2002. METHODS: Data on all retreatment cases were studied as to the condition of the original treatment and factors leading to the retreatment. RESULTS: Of the 47 cases, 33 cases received the original treatment in our hospital. Of the 33 cases, 24 cases were relapsed cases and 9 cases were defaulters. Most relapsed cases were male aged 50s and 12 cases (50%) were jobless. As the factors leading to retreatment, the delay in the negative conversion of sputum culture accounted for 11 cases (45.8%) out of 24 cases. No specific factors were found in three cases (12.5%). Among the defaulters, no bias was seen as to age and occupation of cases, but all the cases were male, and they defaulted during the maintenance phase of treatment at the out-patient department. CONSIDERATION: The delay in the negative conversion of sputum culture was the main factor relating to the relapse. Diabetes mellitus (DM) is one of the factors leading to the relapse, but many factors were observed in DM patients. Male cases aged 50s had many factors leading to the relapse. An intensive management for out-patients and involvement of welfare department aiming at the completion of treatment for the socially vulnerable groups might be necessary as the measure to prevent defaulting. CONCLUSION: The delay in the negative conversion of sputum culture was the main factor leading to relapse, and intensive management for out-patients aiming at the completion of treatment is necessary to prevent the defaulting.     

A study on far-advanced cavitary pulmonary tuberculosis cases

In cases with far-advanced cavitary pulmonary tuberculosis, the most serious lesions according to the chest X-ray classification by the Japanese Society of Tuberculosis (b I 3), their prognosis is believed to be poor due to their emaciated general conditions, and a retrospective clinical study was made on these cases admitted to our hospital. The subjects consisted of 95 cases, and among them 87 were male and 8 were female, and their mean age was 49.5 +/- 13.0 years. Eighty four cases were detected by symptomatic visits to clinics, 10 cases during their treatment for other diseases, and 1 case was discovered accidentally. Sputum examination for acid fast bacilli was all smear positive. As to their social background, the majority were occupied by socially vulnerable groups; 31 cases (32.6%) were jobless on admission, 24 cases (25.3%) were day laborers, and 25 cases (26.3%) were receiving poor relief. Regarding their general condition on admission, 40 cases were very serious and they could not stand by themselves, and their nutritional conditions were poor, and 19 cases (20%) died during hospitalization. All of them were male, and they were found by symptomatic visit to clinics. The period from hospital admission to death was short, the average was 35.0 +/- 39.8 days, and the median was 11.0 days. Among 84 patients detected by symptomatic visit, the patient's delay was 5.5 +/- 5.0 months, while the doctor's delay was 0.3 +/- 0.9 months. Major cause of late detection at advanced stage of these cases was patient's delay which caused poor prognosis of these cases, and various measures to shorten the delay in case-detection must be taken.     

A study on the clinical features of pulmonary tuberculosis in elderly patients

The clinical findings of pulmonary tuberculosis in elderly patients aged 75 years of age or older (elderly group) were compared with the middle-aged patients aged between 45 and 54 years of age (middle-aged group) and the young patients aged 34 years of age or younger (young group). The elderly patients who died in hospital were also compared with the elderly patients who survived. Study subjects were culture-positive pulmonary tuberculosis patients who were discharged from our hospital from December 1996 to November 1998. There were 79 patients in the elderly group, 95 in the middle-aged group, and 88 in the young group. The results were as follows. 1) The male/female ratio was significantly lower in the elderly group (1.9:1) than the middle-aged group (6.9:1). 2) Complication was noted more frequently in the elderly group. However, diabetes mellitus was noted less frequently in the elderly group (12.7%) than the middle-aged group (28.4%). 3) The frequency of cavitation was lower in the elderly group (59.5%) than the middle-aged group (87.4%). 4) The fever over 38 degrees C was noted less frequently in the elderly group (17.7%) than the other groups, while the frequency of the fever over 37 degrees C showed no significant difference between the elderly group and the other groups. 5) The frequencies of hypoalbuminemia and appetite loss were higher in the elderly group than the other groups. 6) The elderly group showed high mortality rate of 31.6%. The complication with cerebrovascular disease was noted significantly higher in the patients who died in hospital than those who survived. The frequency of widespread infiltrates, fever over 38 degrees C, neutrophilia, hypoalbuminemia and appetite loss were all significantly higher in the patients who died in hospital while their sputa were still positive on culture than those who survived. Our study clearly showed the features of elderly pulmonary tuberculosis patients in comparison with middle-aged patients and young patients. These features are very important to suspect the diagnosis of pulmonary tuberculosis in elderly patients with some atypical manifestation. Our study also suggests that the delay in diagnosing tuberculosis causes more frequently the patients' deterioration and death in elderly patients than in middle-aged patients and young patients.     

老年肺结核患者160例临床分析

目的 探讨老年肺结核的临床特点,提高老年肺结核的诊治水平.方法 对2012年1月至2012年12月在我所就诊并登记的160例老年肺结核患者的临床表现、影像学特点、痰菌检查、PPD试验、并发症、抗结核药物不良反应、治疗效果等进行回顾性分析.数据的统计采用SPSS 19.0软件进行.不同年龄段检出率比较采用Fisher确切概率检验;不同组别并发症采用A与非A的构成比比较;P＜0.05为差异有统计学意义,P＜0.01为差异有显著统计学意义.结果 老年肺结核患者占同期登记患者的19.3％（160/828）,症状与体征以咳嗽（142/160,88.8％）、咯痰（125/160,78.1％）为主,其次为食欲减退（82/160,51.3％）;另外,乏力占47.5％（76/160）,消瘦占40.6％（65/160）,气短或气促占39.4％（63/160）,咯血或咯血痰、发热、盗汗分别占18.1％（29/160）、16.2％（26/160）、9.4％（15/160）;肺部渗出、坏死与增殖病变同时存在,以多肺区病变为主（127/160,79.4％）,空洞病灶多见（66/160,41.3％）.PPD试验强阳性率为29.5％（31/105）,60～岁组强阳性率（34.7％,26/105）明显高于70～84岁组（16.7％,5/55）,差异有统计学意义（Fisher确切概率检验,P=0.011）,痰抗酸杆菌涂片和（或）培养检查阳性率高（121/160,75.6％）,菌阳组咳嗽占93.4％（113/121）,菌阴组咳嗽占74.4％（29/39）;菌阳组咯痰占86.8％（105/121）,菌阴组咯痰占51.3％（20/39）,菌阳组咳嗽、咯痰率明显高于菌阴组,差异有显著统计学意义（x2=8.876,P＜0.01;X2=21.743,P＜0.01）.患者有合并症者多见（137/160,85.6％）,其中以肺部感染最常见（77/160,48.1％）,其他合并症为糖尿病（33/160,20.6％）、高血压病（28/160,17.5％）、慢性支气管炎（25/160,15.6％）、肺气肿（22/160,13.8％）等.药物不良反应以药物性肝损伤居多,占22.5％（36/160）.本组患者治愈率为91.3％（146/160）,其中,初治患者治愈率92.4％?     

武汉市社会经济情况和肺结核关系的病例对照研究

目的　研究社会经济情况对肺结核患病的影响,有针对性地采取预防措施。方法 采用1∶1配对病例-对照研究方法,对85对肺结核病例和对照进行问卷调查。应用条件Logistic回归模型进行单因素分析和多因素分析,计算比值比及其95%可信区间。结果 单因素分析中,与肺结核患病相关的因素是人均月收入、就业情况、医疗保障、经济来源,其OR值分别为4.000、5.333、8.000、6.000(χ²=7.200,8.895,5.440,4.880;P<0.05)。全变量条件Logistic多因素分析,最终进入多因素回归模型的有就业情况及人均月收入。结论 无工作、家庭人均月收入低是武汉市肺结核患病的危险因素。     

82例肺结核患者的营养状况调查分析

目的通过对肺结核患者的营养状况调查和对照分析,探讨该类患者合理的营养支持建议。方法将本院2006-2008年住院的82例肺结核患者设为试验组,将本院体检的正常人群78例作为对照组。监测两组患者的身体质量指数(BMI)、血红蛋白(HB)、血清白蛋白(ALB)、总淋巴细胞计数(TLC)等生化指标。结果试验组的体质指数、血红蛋白、血清白蛋白、总淋巴细胞计数明显低于对照组;试验组的营养不良发生率显著高于对照组,具有统计学显著性差异(P0.05)。结论肺结核患者营养不良的发生率较高,应尽早对患者进行营养支持治疗,促进患者康复。     

The study of pulmonary tuberculosis in the elderly]

A clinical study of 52 patients diagnosed as having pulmonary tuberculosis at National Chiba-Higashi Hospital between 1988 and 1990 was performed. The cases ranged in age from 80-89 years; mean male patient age was 82.5, and mean female patient age was 84.3. Diagnosis of the cases were as follows: 19 discovered when checking into hospital because of chest symptoms; 14 diagnosed during the treatment of other diseases; 14 diagnosed during admission to the hospital for other diseases; and five cases were detected by chest X-rays. A total of 38 cases, had received primary treatment for pulmonary tuberculosis, 11 cases had received secondary treatment, and three cases were receiving treatment for tuberculosis. Upon admission to the hospital after the detection of tuberculosis, 19 cases tested positive to sputum smear examinations, six cases tested positive to culture examinations but negative to smear examinations, and culture examinations were negative in 27 cases. Regarding the chest X-ray findings, using the criterion of roentgenological classification for pulmonary tuberculosis established by the Japanese Society for Tuberculosis, two cases revealed type I, 29 cases revealed type II, and 21 cases revealed type III. Cavitary cases were observed in 60% of the chest X-ray findings. Upon hospital admission, 18 cases were observed to have circulatory diseases, 16 cases had central nervous diseases, 12 cases had digestive diseases and 11 cases had respiratory diseases. Nine cases had malignant neoplasm, five cases had diabetes mellitus and 14 cases had other diseases. A total of 18 cases ended in death; six cases died of pulmonary tuberculosis, and 12 cases died of other diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年肺结核患者营养状况评价研究进展

结核病是一种慢性消耗性传染性疾病,与机体营养状况之间存在着双向的关系,相互影响。老年肺结核患者是一个特殊的群体,由于年龄大、抵抗力弱,常多病共存,其营养状况不理想,受多种因素影响。正确评价老年肺结核患者的营养状况是改善其营养摄入的基础。目前,全球针对老年肺结核患者营养状况评价指标的相关研究较多,且各不相同,但缺乏统一评价指标。笔者将国内外老年肺结核患者营养状况评价的相关研究进行综述,为临床进行老年肺结核患者的营养状况评价提供帮助和支持。     

A study on cases developed pulmonary tuberculosis after receiving gastrectomy

OBJECTIVE: Patients who had undergone gastric resection are considered to be high risk of developing tuberculosis. We investigated the factors leading to pulmonary tuberculosis after gastrectomy. MATERIALS AND METHODS: We retrospectively examined 654 pulmonary tuberculosis patients discharged from Chiba-East National Hospital from January 1999 to December 2001. RESULTS: Fifty-five patients (31-84 years old, mean 63.5 +/- 12.5 years, 48 males and 7 females) had the history of gastric resection. The proportion of patients receiving gastrectomy among patients with pulmonary tuberculosis was 8.4 percent. The mean age of patients received gastric resection was 50.2 +/- 16.6 years, and the mean interval from gastrectomy to the development of pulmonary tuberculosis was 13.6 +/- 11.0 years. On admission to our hospital, 34 out of 55 cases were smear positive by sputum examination for acid-fast bacilli and 39 cases had cavitary lesions on chest X-ray. Gastrectomy was done due to carcinoma of the stomach in 31 cases, peptic ulcer in 21 cases, adenomatous polyp in two cases, and accidental injury in one case. Out of total 55 cases, 52 patients improved, but three cases died of pulmonary tuberculosis. None had the recurrence of carcinoma of the stomach. Body weight, Body mass index, Prognostic nutritional index (PNI; 10 x serum albumin concentration + 0.005 x peripheral lymphocyte count) which was proposed by Onodera, serum albumin level and serum total cholesterol level were lower in the gastrectomy group than in the non-gastrectomy group. The odds ratio of developing tuberculosis among gastrectomy patients compared with the appropriate controls in 30 to 59 year-old-men was 3.8. CONCLUSION: This study confirms that gastrectomy is one of the risk factors of developing tuberculosis in 30 to 59 year-old-men. However, whether gastrectomy in itself is a risk factor or whether it is secondarily associated with another risk factor such as underweight status and/or inadequate nutrition following surgery remains unclear.     

老年人肺结核320例临床分析

目的探讨老年人肺结核的临床特征及治疗方法。方法分析320例60岁以上老年人肺结核的临床资料。结果60岁以上肺结核患者病灶范围广、易形成空洞、痰菌阳性率高、合并症多、病程长、症状不典型、易造成误诊。以呼吸道症状就诊的老年人,对原有肺结核病史应加以重视,积极查痰及胸部X线检查,以便早发现,早治疗。结论要加强对老年肺结核的研究,增强对老年肺结核特点的认识,提高其早期诊断和防治效果。     

Study on the pulmonary tuberculosis in the elderly

A study was made for 13 cases of patients over 80 years of age who received medical treatment for tuberculosis. Four factors of onset of tuberculosis at old age were indicated. 1. No opportunity for examination of X-ray for old generation. 2. Atypical shadows on the chest X-ray film. 3. Low stress tolerance. 4. Exacerbation of old tuberculosis during the treatment of other diseases. The results suggest the possibility of increasing pulmonary tuberculosis among the elderly persons in the near future.     

65例老年肺结核合并糖尿病患者的营养状况评价

目的 通过对老年肺结核合并糖尿病患者的营养状况调查和分析,提出合理化营养支持建议。 方法 设老年肺结核合并糖尿病患者组（A组）、单纯老年肺结核患者组（B组）和正常老年人组（C组）,各65例（名）,选择体质指数(BMI)、血红蛋白(Hb)、总淋巴细胞(TLC)、血清白蛋白(Alb)、肌酐-身高指数5项营养指标进行对比分析。两样本间均数差异统计学检验采用t检验,营养不良率差异统计学检验采用χ²检验,P＜0.05为有统计学意义。 结果 (1)A组、B组与C组5种营养指标(BMI、Hb、TLC、Alb、肌酐 身高指数)分别是：A组分别为（18.09±1.88）、(119.30±13.51) g/L、(1.21±0.39)×10⁹/L、(29.76±4.88) g/L、75.44%±7.23%;B组分别为（18.53±2.05）、(126.31±8.76) g/L、(1.28±0.13)×10⁹/L、(37.44±5.46) g/L、76.53%±8.44%;C组分别为（21.11±2.11）、(132.34±8.84) g/L、(2.93±0.53)×10⁹/L、(43.21±7.54) g/L、86.09%±6.75%。A组、B组与C组相比差异均有统计学意义（t_AC值分别是8.58、6.77、6.76、12.03、8.66;t_BC值分别是7.05、3.89、20.98、4.98、5.28。P值均＜0.01）;A组与B组Hb、Alb差异有统计学意义（t值分别为3.51、8.43,P值均＜0.01）。(2) 营养不良率比较：A组分别为44.6%、52.3%、80.0%、64.6%、46.2%。B组不良率分别为38.5%、49.2%、76.9%、46.2%、41.5%。C组不良率分别为6.2%、6.2%、0%、4.6%、7.7%。A、B两组各项指标所得营养不良率均高于C组,有统计学意义（χ²_AC值分别是23.4、31.3、79.7、44.0、24.4;χ²_BC值分别是17.8、28.0、74.3、27.5、20.1。P值均＜0.01）。 结论 老年肺结核合并糖尿病患者营养不良的发生率较高,故老年肺结核合并糖尿病患者更应注重膳食平衡。     

153例老年初治肺结核临床分析

目的　探讨老年初治肺结核诊治和管理措施。方法　对老年肺结核与青年肺结核进行比较分析。结果　 (1)老年肺结核比青年肺结核咯血、乏力、盗汗明显少 ;(2 )结核菌素试验阴性高 ,但两组痰结核菌阳性率差异不明显 (p>0 .0 5 )。(3)前者病灶≥3肺野者明显多 ,而空洞病变两组差异不显著 (p>0 .0 5 )。 (4) I组中三药、四药联合化疗近期 X线好转率、痰菌阴转率也差异不明显 (p>0 .0 5 )。结论　对老年肺结核治疗应选用个体化方案 ,三化方案仍是可取的。同时应重视合并症的治疗及加强管理     

老年与青年空洞型肺结核CT征象比较

目的 分析老年组与青年组菌阳空洞型肺结核的CT特征,以提高对老年空洞型肺结核的认识。方法 回顾性分析2017年1月至2021年1月北京老年医院收治的经痰培养及病理检查确诊的42例老年空洞型肺结核(年龄≥60岁,老年组)和45例青年空洞型肺结核(年龄<45岁,青年组)患者的临床资料,比较2组患者的CT特征。采用SPSS 22.0统计软件进行数据分析。根据数据类型,采用χ²检验进行组间比较。结果 老年组病变累及全肺叶、出现虫噬状空洞、小结节、实变或不张、肺内钙化灶、胸腔积液、纵隔淋巴结肿大及肺门淋巴结肿大的比例明显高于青年组[78.6%(33/42)和31.1%(14/45);42.9%(18/42)和20.0%(9/45);95.2%(40/42)和80.0%(36/45);47.6%(20/42)和24.4%(11/45);57.1%(24/42)和13.3%(6/45);33.3%(14/42)和13.3%(6/45);40.5%(17/42)和15.6%(7/45);28.6%(12/42)和2.2%(1/45)],差异均有统计学意义(均P<0.0...     

老年初治痰涂片阳性肺结核病患者化疗方案选择的对比研究

目的　观察不含吡嗪酰胺 (Z)方案在老年营养不良肺结核病患者治疗中的疗效及副作用。　方法　采用随机配对分组法将 92例老年营养不良肺结核病患者分为试验组 (46例 )和对照组(46例 ) ,两组分别采用 2HR(L)E/ 7HR(L)和 2HR(L)ZE/ 4HR(L)治疗 (H异烟肼 ,R利福平 ,L利福喷丁 ,E乙胺丁醇 )。同期选择初治涂阳肺结核非老年组 40例 ,治疗方案同对照组。　结果　疗程结束后 ,试验组 (9个月后 )、对照组 (6个月后 )、非老年组 (6个月后 )痰菌阴转率分别为 89 1%、80 4%、97 5% (P >0 0 5) ,胸部X线片病灶吸收率分别为 86 9%、82 6%、95 0 % (P >0 0 5) ,肝功能损害发生率分别为 15 2 %、3 9 1%、15 0 % ,对照组肝功能损害发生率显著高于试验组与非老年组 (P <0 0 5) ,停药率分别为 2 2 %、2 1 7%、2 5% ,对照组较试验组及非老年组停药率显著增高 (P <0 0 1) ;1年细菌学复发率分别为 4 8%、2 1 6%、2 7% ,试验组、非老年组低于对照组 (P <0 0 5)。　结论　不含Z初治化疗方案治疗老年痰涂片阳性营养不良肺结核病患者 ,治愈率与常规初治化疗方案相近 ,且发生肝损害率低 ,停药率低 ,值得进一步行远期临床观察研究     

223例复治涂阳肺结核患者治疗现状分析

目的了解北京市复治涂阳肺结核患者治疗现状及效果。方法选择2006—2007年北京市户籍复治涂阳患者,依其年龄、初治地点及就诊机构、初治管理方式、复治疗前药敏试验及合并症、并发病等,对使用2HRZE(S)/6HRE标准复治化疗方案(简称"标化方案")的疗效及非标准复治化疗方案(简称"非标化方案")使用情况进行分析。结果 223例,以中老年居多,占65.5%。治疗前54例进行药敏试验,耐药25例,耐药率46.3%(25/54),耐多药率13.0%(7/54)。使用标化复治方案170例,占76.2%,平均治愈率为75.9%。初治失败者治愈率为50%。使用非标化方案53例,占23.8%,原因为耐药、药物不良反应、伴有合并症、并发病等。结论为进一步提高复治病例的治愈率,在标化复治方案的基础上,对初治失败者复治前应作一、二线抗结核药品的药物敏感试验,并根据试验结果及个体状况。对不宜采用标化方案者可制定有效的个体化方案。