Yagi Takenori, Yamagishi Fumio, Sasaki Yuka, Itakura Meiji, Fujikawa Ayako, Kuga Meiji, Ishimaru Go
Division of Thoracic Disease, National Hospital Organization Chiba-East National Hospital, 673, Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712, Japan.
Kekkaku. 2004 May;79(5):355-9.
Patients who had undergone gastric resection are considered to be high risk of developing tuberculosis. We investigated the factors leading to pulmonary tuberculosis after gastrectomy.
We retrospectively examined 654 pulmonary tuberculosis patients discharged from Chiba-East National Hospital from January 1999 to December 2001.
Fifty-five patients (31-84 years old, mean 63.5 +/- 12.5 years, 48 males and 7 females) had the history of gastric resection. The proportion of patients receiving gastrectomy among patients with pulmonary tuberculosis was 8.4 percent. The mean age of patients received gastric resection was 50.2 +/- 16.6 years, and the mean interval from gastrectomy to the development of pulmonary tuberculosis was 13.6 +/- 11.0 years. On admission to our hospital, 34 out of 55 cases were smear positive by sputum examination for acid-fast bacilli and 39 cases had cavitary lesions on chest X-ray. Gastrectomy was done due to carcinoma of the stomach in 31 cases, peptic ulcer in 21 cases, adenomatous polyp in two cases, and accidental injury in one case. Out of total 55 cases, 52 patients improved, but three cases died of pulmonary tuberculosis. None had the recurrence of carcinoma of the stomach. Body weight, Body mass index, Prognostic nutritional index (PNI; 10 x serum albumin concentration + 0.005 x peripheral lymphocyte count) which was proposed by Onodera, serum albumin level and serum total cholesterol level were lower in the gastrectomy group than in the non-gastrectomy group. The odds ratio of developing tuberculosis among gastrectomy patients compared with the appropriate controls in 30 to 59 year-old-men was 3.8.
This study confirms that gastrectomy is one of the risk factors of developing tuberculosis in 30 to 59 year-old-men. However, whether gastrectomy in itself is a risk factor or whether it is secondarily associated with another risk factor such as underweight status and/or inadequate nutrition following surgery remains unclear.
接受过胃切除术的患者被认为患结核病的风险较高。我们调查了胃切除术后导致肺结核的因素。
我们回顾性研究了1999年1月至2001年12月从千叶东部国立医院出院的654例肺结核患者。
55例患者（年龄31 - 84岁，平均63.5±12.5岁，男性48例，女性7例）有胃切除术史。肺结核患者中接受胃切除术的比例为8.4%。接受胃切除术患者的平均年龄为50.2±16.6岁，从胃切除到发生肺结核的平均间隔时间为13.6±11.0年。入院时，55例患者中有34例痰涂片抗酸杆菌阳性，39例胸部X线有空洞性病变。胃切除术的原因是胃癌31例、消化性溃疡21例、腺瘤性息肉2例、意外伤害1例。55例患者中，52例病情好转，但3例死于肺结核。无胃癌复发病例。胃切除组的体重、体重指数、小野寺提出的预后营养指数（PNI；10×血清白蛋白浓度 + 0.005×外周淋巴细胞计数）、血清白蛋白水平和血清总胆固醇水平均低于非胃切除组。30至59岁男性胃切除患者与适当对照组相比患结核病的优势比为3.8。
本研究证实胃切除术是30至59岁男性患结核病的危险因素之一。然而，胃切除术本身是否为危险因素，或者它是否继发于另一个危险因素，如体重过轻状态和/或术后营养不足，仍不清楚。
