Sato A, Inoue T, Kurasawa T, Ikeda N, Nakatani K, Ikeda T, Yoshimatsu T
National Minami-Kyoto Hospital, Kyoto, Japan.
Kekkaku. 1998 Dec;73(12):733-8.
We evaluated retrospectively the causes of death from active pulmonary tuberculosis by the review of records and chest radiograohs of 364 patients (male 282, female 82) with active pulmonary tuberculosis, who were admitted to our hospital during 1995 to 1998. 43 patients (male 33, female 10) were died under anti-tuberculous chemotherapy. 20 cases were tuberculous death; death from acute progression of tuberculosis without response to chemotherapy (acute progression group) in eight cases and death from debility in spite of partial response to chemotherapy (debility group) in eight cases. 23 cases were died from underlying diseases; death from malignant neoplasmas (malignant group) in nine cases and death from complication of bacterial pneumonia (pneumonia group) in seven cases. In acute progression group, the age (mean +/- SE) was 64.8 +/- 5.2 years old and the survival period from admission was 11.8 +/- 4.2 days. Five cases were laborer or unemployed. This group was characterized with far advanced diseases presenting extensive lung lesions complicated with DIC or hepatic dysfunction, low performance status (PS), severe malnutrition and lymphocytepenia. In debility group, the age was 70.8 +/- 3.9 years old and the survival period from admission was 254.6 +/- 90.7 days. Five cases were laborer or unemployed. This group was characterized with multiple underlying diseases, low PS, previous anti-tuberculous chemotherapy and resistance to INH and/or RFP. In malignant group, the age was 69.3 +/- 3.2 years old and the survival period from admission was 99.9 +/- 21.2 days. This group was characterized with relatively well nourished, relatively good PS in comparison with other groups, and lymphocytepenia. In pneumonia group, the age was 82.8 +/- 1.7 years old and the survival period from admission was 153.3 +/- 54.5 days. This group was characterized with remarkably advanced age, low PS related to underlying disorders of central nervous system. In the causes of death with active pulmonary tuberculosis under chemotherapy, inhomogenous groups were included. Extensive disease, low PS, malnutrition, lymphocytopenia, previous chemotherapy, resistance to INH and/or RFP, and poorer social circumstances seemed to be risk factors for tuberculous death. In contrast, underlying malignant nepolasma, lower PS, and far advanced age were seemed to be the risk factors for non-tuberculous death.
我们通过回顾1995年至1998年期间入住我院的364例活动性肺结核患者（男性282例，女性82例）的病历和胸部X线片，对活动性肺结核的死亡原因进行了回顾性评估。43例患者（男性33例，女性10例）在抗结核化疗期间死亡。20例为结核相关死亡；8例死于肺结核急性进展且化疗无效（急性进展组），8例死于尽管化疗有部分反应但仍因身体衰弱（衰弱组）。23例死于基础疾病；9例死于恶性肿瘤（恶性组），7例死于细菌性肺炎并发症（肺炎组）。急性进展组患者年龄（均值±标准误）为64.8±5.2岁，入院后的生存期为11.8±4.2天。5例为劳动者或无业人员。该组的特点是疾病进展极期，肺部病变广泛，合并弥散性血管内凝血或肝功能障碍，体能状态（PS）差，严重营养不良和淋巴细胞减少。衰弱组患者年龄为70.8±3.9岁，入院后的生存期为254.6±90.7天。5例为劳动者或无业人员。该组的特点是有多种基础疾病，PS低，既往接受过抗结核化疗且对异烟肼和/或利福平耐药。恶性组患者年龄为69.3±3.2岁，入院后的生存期为99.9±21.2天。该组的特点是营养状况相对良好，与其他组相比PS相对较好，以及淋巴细胞减少。肺炎组患者年龄为82.8±1.7岁，入院后的生存期为153.3±54.5天。该组的特点是年龄极高，PS低与中枢神经系统基础疾病有关。在化疗期间活动性肺结核的死亡原因中，包括了不同类型的组。广泛的疾病、低PS、营养不良、淋巴细胞减少、既往化疗、对异烟肼和/或利福平耐药以及较差的社会状况似乎是结核相关死亡的危险因素。相比之下，潜在的恶性肿瘤、较低的PS和极高的年龄似乎是非结核相关死亡的危险因素。
