Kobashi Yoshihiro, Matsushima Toshiharu, Okimoto Niro, Hara Yoshihito
Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kawasaki Medical School Kawasaki Hospital.
Kekkaku. 2002 Dec;77(12):771-5.
We made a clinical analysis of the cause of death of forty deceased patients with active pulmonary tuberculosis who were admitted to Kawasaki Medical School Hospital, Kawasaki Medical School Kawasaki Hospital, and Asahigaoka Hospital during the period from January 1996 to December 2001. The age of 40 deceased patients (29 males/11 females) ranged from 55 to 93 years old, and were mostly bedridden. Underlying diseases existed in all except one case, and they were respiratory diseases in 9 patients and non-respiratory diseases in 34 patients. Laboratory findings revealed poor nutritional conditions. The diagnosis of pulmonary tuberculosis was established within one month from the appearance of symptoms in over half of these patients because most of them were smear positive for Mycobacterium tuberculosis. None of the strains of Mycobacterium tuberculosis isolated from these patients were multidrug resistant for antituberculous drugs and only one strain was completely resistant for Rifampicin. Radiological findings of the tuberculosis were bilateral in 30 patients. Consolidation shadows without cavity were noted in 22 patients, and extension within the unilateral lung field was observed in 24 patients. Regarding the cause of death, advanced pulmonary tuberculosis was the cause in 17 patients and non-tuberculous diseases were the cause in 23 patients. There were 15 patients with bacterial superinfections such as bacterial pneumonia, 4 with malignancy, and 4 with other disease. The number of pulmonary tuberculosis patients in poor general and nutritional condition has been increasing with the aging of the Japanese population. Treatment for pulmonary tuberculosis has been successful in most cases, however, the number of the deaths unrelated to tuberculosis including those due to bacterial superinfection has been increasing. Therefore, treatment should be considered against resistant microoganisms such as MRSA.
我们对1996年1月至2001年12月期间入住川崎医科大学医院、川崎医科大学川崎医院和朝丘医院的40例活动性肺结核死亡患者的死因进行了临床分析。40例死亡患者（29例男性/11例女性）年龄在55岁至93岁之间，大多卧床不起。除1例患者外，其余患者均存在基础疾病，其中9例为呼吸系统疾病，34例为非呼吸系统疾病。实验室检查结果显示营养状况较差。超过半数的患者在出现症状后1个月内确诊为肺结核，因为大多数患者结核分枝杆菌涂片呈阳性。从这些患者中分离出的结核分枝杆菌菌株对抗结核药物均无多重耐药，仅有1株对利福平完全耐药。30例患者肺结核的影像学表现为双侧。22例患者可见无空洞的实变影，24例患者观察到单侧肺野内病变扩展。关于死因，17例患者死于晚期肺结核，23例患者死于非结核性疾病。有15例患者发生细菌重叠感染，如细菌性肺炎，4例患者患有恶性肿瘤，4例患者患有其他疾病。随着日本人口老龄化，全身状况和营养状况较差的肺结核患者数量一直在增加。大多数情况下，肺结核治疗是成功的，然而，与结核无关的死亡人数，包括因细菌重叠感染导致的死亡人数一直在增加。因此，应考虑针对耐甲氧西林金黄色葡萄球菌等耐药微生物进行治疗。
