Tomono K
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Kekkaku. 1998 Dec;73(12):751-4.
We investigated the causes of death of late sequelae of pulmonary tuberculosis. Chronic respiratory failure is one of the most frequent cause of death in the patients of late sequelae of pulmonary tuberculosis. We compared the long term prognosis of chronic respiratory failure in case of emphysema and pulmonary tuberculosis. In the patients with chronic respiratory failure by pulmonary emphysema, the prognosis was poor in those with pulmonary hypertension. But in case of late sequelae of pulmonary tuberculosis, prognosis was not affected by presence or absence of pulmonary hypertension. The determinants of prognosis of late sequelae of pulmonary tuberculosis are the indication of home oxygen therapy, malnutrition, and hypoxemia. Fungal infection, especially aspergilloma, is a common secondary infection of late sequelae of pulmonary tuberculosis. We investigated forty-two cases of aspergilloma as late sequelae of pulmonary tuberculosis, and of those 15 patients died. The causes of death were pneumonia and respiratory failure. Measurement of galactomannan antigen of aspergillus in serum using ELISA or PCR, it was apparent that the outcome was poor in the patients positive for antigen. It suggested that the prognosis of the patients with aspergilloma related with some degree of invasion of Aspergillus in parenchyma. It was reported that neoplasm is closely related to chronic tuberculous empyema. Lymphoma is most frequently complicated with chronic tuberculous empyema, and squamous cell carcinoma, adenocarcinoma, sarcoma and carcinoid were reported as complication of chronic empyema. We reported the case of angiosarcoma, originated from chronic empyema in left thoracic cavity formed after being treated for tuberculosis with artificial pneumothorax. Recently, the number of patients with late sequelae of pulmonary tuberculosis have been decreased, but some severe cases of patients of pulmonary tuberculosis will suffer from late sequelae of pulmonary tuberculosis, and that is still a great problem of the clinical course of pulmonary tuberculosis.
我们研究了肺结核晚期后遗症的死亡原因。慢性呼吸衰竭是肺结核晚期后遗症患者最常见的死亡原因之一。我们比较了肺气肿和肺结核患者慢性呼吸衰竭的长期预后。在肺气肿导致慢性呼吸衰竭的患者中，合并肺动脉高压者预后较差。但在肺结核晚期后遗症患者中，肺动脉高压的有无并不影响预后。肺结核晚期后遗症预后的决定因素是家庭氧疗指征、营养不良和低氧血症。真菌感染，尤其是曲菌球，是肺结核晚期后遗症常见的继发感染。我们调查了42例曲菌球作为肺结核晚期后遗症的病例，其中15例患者死亡。死亡原因是肺炎和呼吸衰竭。使用ELISA或PCR检测血清中曲霉菌的半乳甘露聚糖抗原，抗原阳性的患者预后明显较差。这表明曲菌球患者的预后与曲霉菌在实质内的一定程度侵袭有关。据报道，肿瘤与慢性结核性脓胸密切相关。淋巴瘤最常合并慢性结核性脓胸，鳞状细胞癌、腺癌、肉瘤和类癌也被报道为慢性脓胸的并发症。我们报告了1例血管肉瘤病例，起源于人工气胸治疗肺结核后形成的左胸腔慢性脓胸。近年来，肺结核晚期后遗症患者数量有所减少，但仍有一些重症肺结核患者会出现肺结核晚期后遗症，这仍是肺结核临床病程中的一个重大问题。
