ELISPOT检测在老年肺结核诊断中的应用价值

目的评价结核分枝杆菌特异性IFN-γ酶联免疫斑点(Elispot)检测技术对老年人肺结核的诊断价值。方法对46例老年肺结核、85例中青年肺结核、22例老年非肺结核、97例健康对照,进行Elispot检测并分析该技术诊断老年肺结核的可靠性。结果老年和中青年肺结核Elispot检测的敏感度分别为76.19%和87.5%,特异度分别为84.47%和85.29%。中青年和老年肺结核组Elispot检测阳性率显著高于其它两组(P<0.05)。结论 Elispot检测技术在诊断老年肺结核中显示出较好的敏感性和特异性,阳性率高,可用作老年肺结核的辅助诊断。     

老年人和中青年人肺部感染的对照性研究

目的探讨老年人和中青年人肺部感染的不同临床特点。方法回顾分析我院2005年3月至2007年3月收治的老年肺部感染患者166例和中青年肺部感染患者128例的临床资料。结果老年组多以咳嗽咳痰、胸闷气促为主要症状，而中青年组以发热、胸痛、咳嗽多见（P〈0.01）。老年组中白细胞计数升高者少于中青年组，合并电解质紊乱、Ⅱ型呼吸衰竭者明显多于中青年组，2组比较差异显著（P〈0.01）。痰培养发现老年组中革兰阴性杆菌感染者65例（39．2％）明显多于中青年组21例（16．4％），胸部X线检查示老年组中表现为局限性实变影者4例（2．4％），明显少于中青年组44例（34．4％），2组比较差异显著（P〈0.01）。结论老年人肺部感染临床表现多不典型，在实验室检查、胸部影像学检查方面均与中青年人有着明显不同的临床特点，临床上容易漏诊、误诊，应给予高度重视。     

Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients

BackgroundDue to the general susceptibility of new coronaviruses, the clinical characteristics and outcomes of elderly and young patients may be different.ObjectiveTo analyze the clinical characteristics of elderly patients with 2019 new-type coronavirus pneumonia (COVID-19).MethodsThis is a retrospective study of patients with new coronavirus pneumonia (COVID-19) who were hospitalized in Hainan Provincial People's Hospital from January 15, 2020 to February 18, 2020. Compare the clinical characteristics of elderly with Young and Middle-aged patients.ResultsA total of 56 patients were enrolled 18 elderly patients (32.14%), and 38 young and middle-aged patients (67.86%). The most common symptoms in both groups were fever, followed by cough and sputum. Four patients in the elderly group received negative pressure ICU for mechanical ventilation, and five patients in the young and middle-aged group. One patient died in the elderly group (5.56%), and two patients died in the young and middle-aged group (5.26%). The PSI score of the elderly group was higher than that of the young and middle-aged group (P < 0.001). The proportion of patients with PSI grades IV and V was significantly higher in the elderly group than in the young and middle-aged group (P < 0.05). The proportion of multiple lobe involvement in the elderly group was higher than that in the young and middle-aged group (P < 0.001), and there was no difference in single lobe lesions between the two groups. The proportion of lymphocytes in the elderly group was significantly lower than that in the young and middle-aged group (P < 0.001), and the C-reactive protein was significantly higher in the young group (P < 0.001). The Lopinavir and Ritonavir Tablets, Chinese medicine, oxygen therapy, and mechanical ventilation were statistically different in the elderly group and the young and middle-aged group, and the P values were all <0.05.InterpretationThe mortality of elderly patients with COVID-19 is higher than that of young and middle-aged patients, and the proportion of patients with PSI grade IV and V is significantly higher than that of young and middle-aged patients. Elderly patients with COVID-19 are more likely to progress to severe disease.     

Tuberculosis of the elderly (above the age of 75) in national hospitals

In Japan tuberculosis is becoming rapidly the disease of the elderly. We studied the background, the type and level of hospital cares needed, and the outcome of patients with pulmonary tuberculosis (sputum smear and/or culture positive) above the age of 75 who were admitted to 8 national hospitals during the period from January 1 to December 31, 1997. The study included 150 patients (male: 109, female: 41, mean age: 81.6), of whom 25% needed care in a single-bed room, 84.3% had underlying diseases (cardiovascular diseases: 43.3%, malignant diseases: 20.9%, neuro-psychiatric diseases: 13.4%), and 47.6% needed cares mainly in feeding and excretions. 92 patients (62.6%) improved and 45 patients (30.6%) died, of whom the cause of death was directly related to tuberculosis in 42. The mean hospital stay was 4.7 months. However, in 42 patients whose cause of death was related to tuberculosis, 66% died within 3 months, while in 102 patients who were discharged 71% stayed more than 3 months. The same comparison was done in 508 patients with bacteriologically proven tuberculosis above the age of 75 admitted to National Tokyo Hospital during the period from 1990 to 1999. The result was almost the same, among 133 patients died in the hospital 60% died within 3 months, while in 375 patients who were discharged hospital stay was more than 3 months in 70%. In the near future, the elderly will occupy more than 25% of the beds of the tuberculosis ward in Japan and most of them have underlying diseases other than tuberculosis. Because tuberculosis, once the disease of the young, is becoming rapidly the disease of the elderly, it is imperative for us to make necessary adjustments to meet this inevitable trend.     

老年冠心病患者的临床及冠状动脉造影特点

目的: 探讨老年冠心病患者的临床及冠状动脉造影（CAG）特点。方法: 2007年2月～2008年3月冠心病患者275例,根据年龄分为中青年组（<60岁,n=100)和老年组（≥60岁,n=175),对两组患者一般资料、血生化指标及CAG结果进行回顾性分析。结果: 老年组高血压病患病率显著高于中青年组(62% vs 39%,P<0.01),且血尿酸水平明显高于中青年组（P<0.05）。老年组以多支病变较多 (P<0.01)。老年组左回旋支(LCX)和右冠状动脉(RCA)病变均明显高于中青年组（P<0.01）,老年组ACC/AHA积分和弥漫长病变多于中青年组(P<0.01)。结论: 老年冠心病多并发高血压病和高血尿酸,病变程度较重且较弥漫。     

Autoimmune pancreatitis in young patients

GOALS: To examine whether there is a difference in the autoimmune pancreatitis (AIP) seen in young and elderly patients. BACKGROUND: AIP has a preponderance for elderly males, although the reason is unknown. STUDY: A total of 64 patients with AIP were divided into a young (<40 y old) group and a middle-aged or elderly group (> or =40 y old) according to the age at diagnosis. The clinical findings of each group were compared. RESULTS: The young group consisted of 6 patients (3 men, 3 women) with a mean age of 33.0 (range, 28 to 37) years. In the middle-aged or elderly group, there were 58 patients with a mean age of 66.4 (range, 46 to 83) years; males predominated (79%). Abdominal pain as the presenting symptom was significantly more frequent in the young group than in the middle-aged or elderly group (100% vs. 43%, P<0.05). Obstructive jaundice was detected in only 17% (1/6) of patients in the young group compared with 59% (34/58) of patients in the middle-aged or elderly group. Serum amylase elevations were detected more frequently in the young group than in the middle-aged or elderly group (83% vs. 40%, P<0.05). One young patient also had ulcerative colitis. CONCLUSIONS: Although rare in Japan, young patients with AIP show different clinical features from middle-aged or elderly patients with AIP; young patients are more likely to have abdominal pain and serum amylase elevations.     

Tuberculous infection and prevention

In Japan, the number of tuberculosis infected patients has been increasing again, especially in the elderly. The incidence of newly registered tuberculosis patients who are over 70 years is 34%. The outbreak of tuberculosis also has been increasing, and has become a serious social problem. The elderly have a high risk of developing tuberculosis because of their immunosuppressed condition due to underlying disease and aging. Elderly active tuberculous people also confer a risk of tuberculosis infection to the non-tuberculosis infected young generation. In this symposium, we discussed about 1) the tuberculosis outbreak related to the strategy for tuberculous prevention, 2) the health examination to detect tuberculous people in the middle-aged and elderly, 3) the nosocomial transmission of tuberculosis in the hospital, 4) the nutritional damage and immunosuppressive state in elderly people related to developing active tuberculosis in latent tuberculous infection, and 5) the organ transplantation and tuberculosis focusing on living related liver transplantation. Seven cases of tuberculosis outbreak were reported in Osaka from 1989 to 1998, 2 cases in the hospital and 5 in others. Tuberculous infection index (maximum sputum Gaffky score multiplied by the number of months of persisted cough) was 8 and 15 in the hospital, 3, 0, 84, 14, and 27 in others. Three cases (43%) were observed in persons with less than 10 of this index. It is essential to evaluate carefully for tuberculosis outbreak in extraordinary examination, if the tuberculous infectious index is low. There are various immunosuppressive patients with malignancy and other underlying disease in the hospital, so we have to pay careful attention for tuberculous outbreak when there is an active tuberculous patient. In these seven cases of extraordinary examination for tuberculous epidemic, only one (0.4%) of 241 cases who received isoniazide prophylactic therapy developed active tuberculosis. Isoniazide prophylactic therapy was an important strategy for the prevention of tuberculous outbreak. (Isamu TAKAMATSU, Osaka Prefectural Habikino Hospital, Osaka). It is essential to prevent tuberculosis in the elderly to achieve tuberculosis control in public health. The health examination was an important strategy for the detection of tuberculosis in the middle-aged and elderly. The incidence of tuberculosis detection is only 9.3% by the health examination at this age. However, the health examination has well detected active tuberculosis patients in elderly (34.5%), and also 16.8% in smear positive cases with pulmonary cavitary formation. The early detection of persons with active tuberculosis is essential, and further discussion regarding cost-performance and accuracy of the health examination for tuberculosis should also be essential. Prophylactic therapy of isoniazide also might be considered for the high risk middle-aged and elderly people with underlying diseases. (Masako OMORI et al., Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo). The cases of nosocomial transmission of tuberculosis in the hospital have been increasing. In younger persons, the incidence of tuberculosis infected nurses and doctors is relatively higher than healthy control. The transmission of tuberculosis from elder active tuberculosis patients to healthy non-tuberculosis infected medical workers has been well recognized. It is very essential to follow guidelines for the prevention of tuberculous transmission in the hospital from the Japan Tuberculosis Society including routine tuberculin skin test for fresh medical workers. Primary education for tuberculosis in medical and nursing school is also an important strategy. Further discussion might be essential that BCG could prevent tuberculosis transmission in tuberculin skin test negative adults. (ABSTRACT TRUNCATED)     

老年人糖尿病与结核病并存临床特点的探讨

目的　探讨老年人糖尿病与结核病并存的临床特点。　方法　对 1 1 8例老年糖尿病并存肺结核患者与 69例非老年患者进行临床对照分析。　结果　先患糖尿病后发现肺结核、肺结核并存空洞者、重症肺结核、有并发症者例数和病死率 ,老年组分别为 85例 ( 72 %)、68例 ( 57.6%)、66例( 55.9%)、61例 ( 51 .7%)、1 3例 ( 1 1 %) ;非老年组分别为 3 5例 ( 50 .7%)、2 5例 ( 3 6.2 %)、2 7例( 3 9.2 %)、8例 ( 1 1 .6%)、3例 ( 4%)。两组比较差异有显著性 (分别为 P<0 .0 1和 P<0 .0 5)。　结论　老年人糖尿病并存结核病发病率高 ,易患空洞 ,病情严重且死亡率高 ;早期监测、预防与治疗、防止并发症的发生十分重要。     

80岁以上老年急性胰腺炎患者的临床特征分析

目的探讨≥80岁老年急性胰腺炎(AP)患者的临床特征。方法回顾性分析2013年1月—2019年12月西南医科大学附属医院消化内科收治的3642例AP患者,分为青年组(<65岁,n=2955)、中老年组(65~79岁,n=558)、老年组(≥80岁,n=129例)。收集并统计分析3组患者的资料信息,包括性别、年龄、病因、诱因、既往病史、病情严重程度、并发症和临床转归等。符合正态分布的计量资料3组间比较采用one-way ANOVA检验,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料3组间比较采用Mann-Whitney U检验;计数资料3组间比较采用χ2检验或Fisher精确概率法,有序多分类变量比较采用Kruskal-Wallis H检验。结果中老年组和老年组女性比例均高于青年组(P值均<0.05);老年组并发高血压比例均高于中老年组和青年组(P值均<0.05);老年组并发高脂血症比例低于青年组(P<0.05)。3组AP患者均以高脂饮食为主要诱因,老年组因酒精、高脂饮食+酒精诱发AP比例均低于青年组(P值均<0.05);老年组以胆道疾病为病因的比例高于中老年、青年组(P值均<0.05),而高脂血症、酒精、胆道疾病+高脂血症比例均低于青年组(P值均<0.05)。老年组中发生轻症急性胰腺炎83例(64.3%),中度重症急性胰腺炎23例(17.8%),重症急性胰腺炎23例(17.8%),与中老年组及青年组相比,病情严重程度构成比例差异均有统计学意义(P值均<0.05);老年、中老年组复发比例均低于青年组(P值均<0.05)。在全身并发症方面,老年组发生肺炎、急性肾损伤、多器官功能障碍综合征的比例均高于青年组(P值均<0.05)。老年组治愈病例比例均低于中老年组和青年组(P值均<0.05),好转病例比例均高于中老年组和青年组(P值均<0.05)。老年组和中老年组放弃治疗比例均高于青年组(P值均<0.05)。老年组死亡1例(0.8%),中老年组死亡9例(1.6%)、青年组死亡16例(0.5%),3组间比较差异无统计学意义(P>0.05)。3组患者住院天数及住院费用比较差异均无统计学意义(P值均>0.05)。结论≥80岁AP患者以女性为主,多由胆源性因素引起,易并发肺炎、急性肾损伤、多器官功能障碍综合征。     

Comparison of younger and elderly patients with pulmonary tuberculosis

A comparison of the clinical features, predisposing factors, drug-induced adverse effects and diagnostic approach in pulmonary tuberculosis in 37 younger and 35 elderly men was carried out. Elderly patients had a higher number of underlying diseases, including cardiovascular diseases and hypertension, than younger patients. The classic symptoms and signs of tuberculosis, such as productive cough, fever and general fatigue, were observed in relatively high proportions of both patients, whereas weight loss (43 vs. 16%) and crackles in the lung fields (49 vs. 16%) were significantly higher in the elderly patients than the younger ones. As for roentgenographic abnormalities, a higher involvement of middle and lower lung fields was seen in the elderly patients than in the younger. Although leukocytosis was noted in a significantly lower proportion of the elderly patients, neutropenia due to drug treatment was significantly higher (23%) than in younger patients (5%). In a mass survey, the detection of pulmonary tuberculosis in elderly men was significantly lower (23%) than that in younger men (54%), suggesting that an extensive mass survey for pulmonary tuberculosis in elderly men should be done.     

患者年龄对无创通气治疗 ARDS 的结局影响

目的：本研究分析接受无创正压通气治疗的不同年龄阶段的 ARDS 患者的各项指标,统计 ARDS 患者的原发病和并发症,探讨无创正压通气的有效性和结局。方法收集2009~2015年诊断为 ARDS 且采用无创正压通气治疗的患者236例,将患者分为四组,18~44岁为青年组,45~59岁为中年组,60~74岁为老年前期组,75岁及以上为老年组；对其进行统计分析。结果老年前期组ARDS 患者选择无创正压通气治疗的比例最高(40.25%),青年组最小(6.36%)。老年组的体质量指数(BMI)指数为(22.71±1.6)kg/m2显著低于其他三组。ARDS 患者的急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分显示,青年组和中年组显著高于老年前期组和老年组。四组 ARDS患者的心率,青年组>中年组>老年前期组>老年组,且差异有统计学意义。青年组患者的 pH 显著高于其他各组。四组患者无创正压通气治疗的成功率(χ2=0.540,P =0.910)和病死率(P =0.481)差异均无统计学意义。对于无创正压通气治疗 ARDS 患者的持续时间,老年前期组显著高于其他三组,患者的住院时间,青年组显著高于其他三组。ARDS 患者人数原发病与并发症较多的是急性 COPD,心源性肺水肿以及呼吸道病变。结论大于60岁的 ARDS 患者接受无创正压通气治疗的比率高于18~60岁患者,无创正压通气的成功率以及 ARDS 患者的病死率在各年龄阶段间差异无统计学意义。     

Manifestations of pulmonary tuberculosis in the elderly: a prospective observational study from north India

BACKGROUND: There is scarcity of published literature on manifestations of pulmonary tuberculosis (PTB) among elderly patients in India. The aim of the present study was to compare the clinical, radiological and laboratory manifestations of PTB among young and elderly patients. METHODS: This prospective study involved 100 human immunodeficiency virus (HIV) negative patients with PTB. The demographic, clinical, radiological and laboratory manifestations were compared between young (n=50; under 60 years of age) and elderly (n=50; aged 60 years and above) with PTB. RESULTS: Elderly patients, in comparison to younger patients, tended to be heavier smokers and had more co-morbidities (40% vs 8%; p < 0.05). They presented more frequently with constitutional symptoms (except fever) and less frequently with respiratory symptoms. The mean duration of symptoms and rate of sputum smear-positivity for acid-fast bacilli was similar in both groups. Both the groups were similar with respect to physical examination and chest radiograph findings. Median values of erythrocyte sedimentation rate and total leukocyte count were significantly higher and lower respectively in the elderly patients. CONCLUSIONS: The presentation of PTB in elderly patients differs from that of younger patients by the predominance of constitutional rather than respiratory symptoms. A high index of suspicion is required to make a timely diagnosis of tuberculosis in the elderly.     

老年人与中青年人大肠息肉临床特点对比研究

目的探索老年人大肠息肉的临床特征。方法收集在上海中医药大学附属曙光医院2006年1月-2019年12月行电子结肠镜检查并且病理证实为大肠息肉的患者1000例,进行回顾性研究,按年龄分为老年组576例,中青年组424例。统计分析老年大肠息肉患者的临床症状、息肉大小、形态、部位、数目、息肉病理分型及其与息肉癌变的相关性,同时与中青年组比较。结果老年组最常见的临床表现为便血或粪隐血阳性(48.1%)及腹胀(45.8%),中青年组主要表现为腹胀(26.7%)和便秘(25.7%);2组患者均以无蒂、多发息肉多见,左半结肠是息肉好发部位;2组均以<2 cm的息肉多见;老年组≥2 cm的息肉多于中青年组(6.2%vs 3.6%,P=0.008);2组病理分型均以管状腺瘤为主,老年组管状绒毛状腺瘤比例高于中青年组(12.6%vs 7.6%,P=0.000);癌变率男女性间无差异;老年组息肉癌变率高于中青年组(9.7%vs 4.7%,P=0.004),左半结肠息肉、无蒂息肉、绒毛状腺瘤、>2 cm息肉癌变率高;老年组<2 cm息肉癌变率高于中青组(2.4%vs 1.0%,P=0.014)。结论腹胀、便血或粪隐血阳性是老年大肠息肉患者常见临床表现,老年患者大肠息肉癌变率高于中青年患者,大肠息肉的癌变率与年龄、息肉大小、部位、病理分型密切相关。     

The causes of death in patients with non-MDR pulmonary tuberculosis in our hospital

We studied the causes of death in 295 patients (mean (+/- SD) age 70.5 +/- 13.2 y.o.) with active non-MDR pulmonary tuberculosis who died in our hospital between 1991 and 1999. A hundred and twenty eight patients (43.4%, group A) died of tuberculosis, while 167 patients (56.6%) of other accompanying diseases. In 46 patients of the latter (15.6%, group B), pulmonary tuberculosis gave an unfavorable impact on their clinical course. In these patients the extent of pulmonary tuberculosis on chest roentgenograph was similar with the remaining 121 patients who also died of the accompanying diseases (41.0%, group C) and was less severe than those of the group A patients. Their nutritional conditions measured by serum albumin and choline-esterase level on admission, however, were as low as those of the group A patients and distinctly worse than those of the group C patients. Most patients of groups A and B died within 3 months after admission, while less than half patients of group C died during the same period. The age frequency distribution of the patients in groups B and C had a single peak in the age group 70 to 89, while that in group A showed two peaks, one similar peak as in groups B and C, and another peak in the age group 50 to 59. The numbers of homeless patients, of the patients with extensive cavitary lesions, and of the patients who died of ARDS (Adult Respiratory Distress Syndrome) or severe pneumothorax in group A were the most also in the age group 50 to 59, indicating that the patients' delay in admitting to hospitals was the major cause of high motality in this age group. As to detailed causes of death in group A, patients died of respiratory failure (32 cases), emaciation (28 cases), progression of pulmonary tuberculosis (20 cases), ARDS (15 cases), tuberculosis-related diseases such as pneumothorax, hemoptysis, and DIC (24 cases). In groups B and C patients died of organ failure (36 cases), infectious diseases (33 cases) and malignancy (30 cases). The total number of died patients has increased, and the proportion of cases dying of ARDS and infectious diseases has increased statistically significantly recently.     

Evaluation on the clinical background on early death in patients with pulmonary tuberculosis during the past five years

We evaluated the clinical background of early death (within 3 months after admission to our hospital) in patients with active pulmonary tuberculosis during the past five years (1992-1996). Among 65 active pulmonary tuberculosis patients who died during the past five years, 32 (49%) died directly of tuberculosis. Thirteen (41%) of those 32 patients died of acute respiratory failure and 9 patients (28%) died in emacitation state. Twenty two patients (69%) died within 3 months after admission to our hospital (the early death group) and 10 patients (31%) died after 3 months (the late death group). Thirteen patients (59%) in the early death group died of acute respiratory failure. On the other hand, none in the late death group died of acute respiratory failure but 4 patients died of chronic heart and/or respiratory failure and 4 patients died in emarciation state. Compared to the patients in the late death group, more patients in the early death group had long total delays (patient's and doctor's delays), had coexisiting diseases, had fallen into acute respiratory failure, and were under malnutrition. We evaluated the nutritional condition of patients using the Onodera's PNI (Prognostic Nutritional Index; 10 x serum almumin concentration + 0.005 x peripheral lymphocyte count) and the PNI value was lower among the patients in the early death group than among those in the late death group. To prevent death due to tuberculosis, we emphasize that it is important to start anti-tuberculosis therapy before patients fall into acute respiratory failure and/or malnutrition.     

Myocardial infarction in young patients: an analysis by age subsets

We examined, in age subsets, 2643 patients with acute myocardial infarction. Clinical features and 1 year morbidity and mortality were compared in 203 young patients (less than 45 years), 1671 patients 46 to 70 years old, and 769 elderly patients (greater than 70 years). Ninety-two percent of young patients were men, and a family history of premature coronary artery disease was more common in young patients (41% compared with 28% of middle-aged and 12% of elderly patients). More young patients were currently smoking cigarettes (82% compared with 56% of middle-aged and 24% of elderly patients), and only 8% of young patients had never smoked. Previous myocardial infarction and history of angina pectoris or congestive heart failure were less common (p less than .001) in the young patients than in middle-aged and elderly patients. In-hospital mortality was only 2.5% for young patients, compared with 9.0% in middle-aged and 21.4% in elderly patients (both p less than .001). Postdischarge 1 year mortality was also strikingly low in young patients, at 2.6% compared with 10.3% in middle-aged and 24.4% in elderly patients. The incidence of reinfarction during the 1 year of follow-up was similar in all subsets. The statistical significance of 65 variables as predictors of 1 year mortality and reinfarction was tested and the following found to be significant (p less than .05): hospital discharge on antiarrhythmic drugs, digoxin, or diuretics; history of previous myocardial infarction or congestive heart failure; chest x-ray findings of heart failure; low ejection fraction; and atrial fibrillation. Thus, young patients entering the hospital have an excellent 1 year prognosis, but those with prior infarction in whom there are selected abnormal findings at hospital discharge comprise a subgroup that may benefit from early aggressive management.     

综合医院住院老年患者活动性肺结核88例分析

目的了解综合医院住院老年患者中活动性肺结核患者的发病及入院前后诊疗情况,探讨老年肺结核患者诊治延误的原因,以提高综合医院对老年肺结核的诊治水平。方法回顾性分析2002年1月～2007年12月我院以肺结核（活动性）转、出院的老年患者88例的临床资料,包括临床症状、辅助检查和诊治情况等。结果（1）呼吸科病例占多数,且每年病例数逐年增加;（2）入院前临床症状以发热、咳嗽、咳痰喘为主;（3）83例患者有基础疾病或合并其他疾病,主要基础疾病为肺部疾病、糖尿病、心脑血管疾病及营养不良;（4）误诊为其他疾病而收入院5例（占5．7％）,因其他疾病或合并疾病收入院后发现合并肺结核83例（占94．3％）,以慢性喘息性支气管炎等肺部疾病为主;（5）入院前81例进行了胸片检查,均未提示肺结核,入院后CT检查明确诊断率为86．7％;（6）入院前均未作痰涂片结核菌检查,入院后痰涂片结核菌检查例55例（占62．5％）,阳性24例,占涂片病例的43．6％;（7）10天内诊断及转诊病例42例（占47．7％）,12例患者超过1个月（占13．6％）。结论老年肺结核患者延误诊断主因是并存其他疾病使其不典型,综合医院门诊应进一步加强门诊老年患者结核病的排查工作,对怀疑不典型肺结核的患者应该进行痰涂片及肺CT检查,以便早诊断,早转诊。     

98例青年人与66例老年人涂阳肺结核临床分析

目的探讨青年人与老年人涂阳肺结核的诊治和管理措施。方法对98例青年人涂阳肺结核和66例老年人涂阳肺结核病例进行比较分析。结果青年人以咳嗽、胸痛、发热、纳差、消瘦、盗汗为主,病程短。老年人以咳嗽、咳痰、气急、消瘦为主,病程迁延漫长,合并症多,临床症状不典型。结论早期诊断和治疗是改善预后的关键,老年组治疗效果欠佳。对因呼吸道症状就诊的老年人,积极查痰及胸部X线检查,以便及早发现,及早治疗。     

30例危重症肺结核孕产妇的临床特征及预后分析

为了解发生危重症肺结核孕产妇的临床特征及预后情况,笔者搜集成都市公共卫生临床医疗中心结核科重症病区2013年1月至2018年6月收治的30例发生危重症肺结核孕产妇(孕妇21例,产妇9例)的临床资料进行分析。结果显示,患者症状以发热(90.0%,27/30)、气促(86.7%,26/30)、咳嗽(76.7%,23/30)多见;结核病类型以血行播散性肺结核为主(73.3%,22/30),33.3%(10/30)并发肺外结核。30例患者中,11(36.7%)例行体外受精-胚胎移植(IVF-ET)术;患者院内死亡4例,2例病情恶化自动出院后电话随访死亡;9例产妇院外分娩活婴,14例孕妇引产或流产,4例孕妇院内分娩活婴,3例孕妇继续妊娠。综上,发生危重症肺结核孕产妇的临床表现缺乏特异性,以血行播散性肺结核为主,应及时诊断、规范治疗以改善预后;同时,建议拟行IVF-ET 术的妇女行结核病相关项目的筛查。     

A study on low performance status cases of pulmonary tuberculosis in the elderly

The subjects consisted of 42 patients aged over 60 years, whose performance status (PS) was grade 3 or 4, and who had been admitted for pulmonary tuberculosis at National Chiba-Higashi Hospital between 1997 and 1998. The average age (+/- SD) of the 34 men and 8 women was 77.6 (+/- 8.5) years (range, 60-91 years). The mean stay in the hospital of the improved patients was 166.6 days (range, 57-303 days), and the mean survival period from admission to death was 43.4 days (range, 2-179 days in died patients). On admission to our hospital, 26 cases were sputum smear positive, 8 cases were smear negative and culture positive, and 8 were negative both on smear and culture. The cavity was observed in 30 cases (71.4%) on the chest X-ray. The laboratory data on admission revealed low nutritional condition. The mean serum total protein, albumin, and cholesterol level on admission were 6.2 (+/- 0.82) g/dl, 2.7 (+/- 0.62) g/dl, and 143.0 (+/- 41.9) mg/dl. Most of the patients had a difficulty in taking foods, and 20 cases (47.6%) were performed parenteral nutrition by central venous catheter. 23 cases (54.8%) received oxygen therapy by facial mask or nasal tube. The most common cause of low PS on admission was pulmonary tuberculosis in 14 cases (33.3%), followed by cerebrovascular diseases in 11 cases, and orthopedic disease in 8 cases. The proportion of patients whose cause of low PS was not due to lung tuberculosis increased with age. Observing the mortality by the route of administration of antituberculosis medications on admission, 19 (55.9%) of 34 cases who could take drugs per oral route died. One (50.0%) of 2 cases who were administered drugs through gastric tube died, and all (100.0%) of 5 cases who could not take drugs per oral route and were injected isoniazid and streptomycin died. One case who could not administer any drug died. 16 cases improved and 26 cases died, of whom the most common cause of death was pulmonary tuberculosis in 11 cases (42.3%), followed by bacterial pneumonia in 5 cases, and cerebrovascular disease in 3 cases. The mortality by the PS on admission were as follows: 10 (47.6%) of 21 cases with PS 3 died. 16 (76.2%) of 21 cases with PS 4 died. 16 (6.4%) of 249 cases aged over 60 years with PS 0, 1 or 2, and were admitted for pulmonary tuberculosis at the same hospital during the same period died. This study confirms that the prognosis of low performance status patients of pulmonary tuberculosis in the elderly was significantly poor. We have to detect tuberculosis patients in the early stage, and give them antituberculosis medications per oral route as far as possible.