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％?

Clinical analysis of 160 elderly pulmonary tuberculosis cases

Objective To investigate the clinical characteristics of elderly pulmonary tuberculosis （PTB）,and to improve the level of diagnosis and treatment of elderly PTB.Methods The clinical manifestations,imaging features,sputum examination results,PPD test results,complications,adverse reaction of anti tuberculosis drugs and treatment effects of 160 elderly cases of PTB,who registered in Antituberculosis Institute of Shantou from January 2012 to December 2012,were analyzed retrospectively.SPSS 19.0 software was used for statistics.The detection rates of different ages were compared by Fisher exact probability test,comparison of complications in different groups was conducted by the composition of A and non A.P＜0.05 was considered statistically significant and P＜0.01 was considered significant difference.Results Elderly PTB cases accounted for 19.3％ （160/828） of cases registered in the corresponding period.Cough （142/160,88.8％） and expectoration （125/160,78.1％） were the main symptoms,followed by loss of appetite （82/160,51.3 ％）.Cases with fatigue accounted for 47.5 ％ （76/160）,with weight loss accounted for 40.6％ （65/160）,with shortness of breath accounted for 39.4％ （63/160）,with hemoptysis sputum,fever,night sweat accounted for 18.1％ （29/160）,16.2％ （26/160） and 9.4％ （15/160） re spectively.Pulmonary infiltration,necrosis and proliferative lesions co exist,most of the lesions was multiple lung area lesion （127/160,79.4％） and cavitary lesions were common （66/160,41.3％）.The strong positive rate of PPD test was 29.5％ （31/105）,and that of 60 years old group and above （34.7％,26/105） was significantly higher than that of 70 to 84 age group （16.7％,5/55） （Fisher＇s exact test,P 0.011）.Sputum acid fast bacilli （smear and/or culture） positive rate was high （121/160,75.6％）.Cases in positive bacteria group with cough accounted for 93.4％ （113/121）,while those in negative group accounted for 74.4％ （29/39）.Cases wi