Xie H J, Enarson D A, Chao C W, Allen E A, Grzybowski S
Division of TB Control, University of British Columbia, Vancouver, Canada.
Tuber Lung Dis. 1992 Apr;73(2):77-82. doi: 10.1016/0962-8479(92)90059-S.
Records of all 1884 newly notified tuberculosis cases, over the 5-year period 1980-1984 in British Columbia, Canada, were reviewed and 201 deaths were identified, including 48 diagnosed only after death, and 153 who died while on treatment; 56 of unrelated causes, 67 in whom tuberculosis was a contributing cause, and 30 in whom it was the principal cause. Significant predictors of death while on treatment (specific to tuberculosis) were the extent of disease, history of previous disease and sputum smear-positive for acid-fast organisms. Significant predictors of failure of diagnosis, in patients who died, were the presence of disseminated disease and the absence of a history of previous disease. The presenting features were not different in those dying, in whom the diagnosis was made before, as compared with after, death. The most frequent mode of death due to tuberculosis was respiratory failure, followed by multiple organ system failure and haemoptysis. The case fatality rate was low (1.6%) and did not change over 10 years. One-half of patients whose death was due to tuberculosis were diagnosed only after death and this had not changed over 10 years. We conclude that death due to tuberculosis is uncommon in patients while on treatment and that the main reason for death due to tuberculosis is that some patients are not diagnosed, and therefore not treated, before they die of the disease.
对加拿大不列颠哥伦比亚省1980 - 1984年这5年间新报告的1884例结核病病例记录进行了回顾，确定了201例死亡病例，其中48例仅在死后才被诊断，153例在治疗期间死亡；56例死于无关原因，67例结核病是促成死因，30例结核病是主要死因。治疗期间死亡（特定于结核病）的显著预测因素是疾病范围、既往病史以及痰涂片抗酸菌阳性。在死亡患者中，诊断失败的显著预测因素是播散性疾病的存在以及无既往病史。与死后才确诊的患者相比，死前确诊的患者的临床表现并无差异。结核病最常见的死亡方式是呼吸衰竭，其次是多器官系统衰竭和咯血。病死率较低（1.6%），且10年间未发生变化。因结核病死亡的患者中有一半仅在死后才被诊断，且这一情况10年间未发生变化。我们得出结论，结核病患者在治疗期间死于结核病并不常见，结核病导致死亡的主要原因是一些患者在死于该病之前未被诊断，因此未得到治疗。
