Yamagishi F
Division of Thoracic Disease, National Chiba Higashi Hospital, Japan.
Kekkaku. 2001 Feb;76(2):77-81.
Recently compromised hosts have increased due to aging of population, advance of medical technology and therapy or changes in the dietary life and social life. Concomitantly the proportion of compromised hosts in the patients with pulmonary tuberculosis has also increased. Taking up diabetes mellitus, hemodialysis, collagen disease and lung cancer as the representatives of compromised hosts, we studied the propriety of chemoprophylaxis to prevent the development of tuberculosis and the standard for the subjects in the case of chemoprophylaxis being given. Diabetics top the patients in the high risk group of developing pulmonary tuberculosis. Therefore, giving chemoprophylaxis is considered necessary to prevent the development of tuberculosis from diabetics. Chemoprophylaxis to diabetics should be given only when healing of tuberculosis has been found despite the history of treatment for tuberculosis being absent. In the patients of hemodialysis, the total morbidity of tuberculosis is high, but the morbidity of pulmonary tuberculosis is not too high, so chemoprophylaxis for the patients on hemodialysis is not always necessary. However, chemoprophylaxis according to the same standard for diabetics is necessary for the patients with diabetic nephropathy. In the patients with collagen disease except rheumatoid arthritis under consideration for administration of corticosteroid preparations, chemoprophylaxis is considered desirable where doses of more than 10 mg in terms of prednisolone are administered over a long period of time. In the patients with lung cancer under consideration for administration of corticosteroid preparations, chemoprophylaxis is considered desirable where doses of more than 10 mg in terms of prednisolone are administered over a long period of time.
近年来，由于人口老龄化、医疗技术和治疗方法的进步以及饮食和社会生活的变化，免疫功能受损宿主的数量有所增加。与此同时，肺结核患者中免疫功能受损宿主的比例也有所上升。我们以糖尿病、血液透析、胶原病和肺癌作为免疫功能受损宿主的代表，研究了预防结核病发生的化学预防的适宜性以及进行化学预防时的对象标准。糖尿病患者在发生肺结核的高危人群中位居榜首。因此，为预防糖尿病患者发生结核病，进行化学预防被认为是必要的。仅当虽无结核病治疗史但已发现结核病治愈时，才应对糖尿病患者进行化学预防。在血液透析患者中，结核病的总发病率较高，但肺结核的发病率并不太高，因此并非总是需要对血液透析患者进行化学预防。然而，对于糖尿病肾病患者，按照与糖尿病患者相同的标准进行化学预防是必要的。对于考虑使用皮质类固醇制剂的除类风湿关节炎外的胶原病患者，当以泼尼松龙计长期给予超过10毫克的剂量时，进行化学预防被认为是可取的。对于考虑使用皮质类固醇制剂的肺癌患者，当以泼尼松龙计长期给予超过10毫克的剂量时，进行化学预防被认为是可取的。
