Yamagishi Fumio
Department of Respiratory Diseases, National Hospital Organization Chiba-East National Hospital, Chiba, Japan.
Kekkaku. 2006 Oct;81(10):631-8.
We investigated the clinical features and measures for tuberculosis with diabetes mellitus, AIDS, gastrectomy, malignant tumor, or receiving anti-tumor necrosis factor-alpha. In these days, tuberculosis patients with diabetes mellitus are increasing. Their tuberculosis is often found in advanced cases and the periods of symptomatics are short. In short, in tuberculosis with diabetes mellitus, the progress of tuberculosis is fast. Japanese patients of tuberculosis with AIDS are frequent in mid-life and increasing. Extra-pulmonary tuberculosis including disseminated tuberculosis is frequent with patients of AIDS. The prognosis of them is improved with the spread of HAART treatment. The most frequent occasion for gastrectomy is gastric cancer and the prognosis is good. Many of them are thin and malnutrition. The prognosis of tuberculosis with malignant tumor is bad, especially with lung cancer and malignant lymphoma. People receiving infliximab, an antitumor necrosis factor-alpha, are frequent to have onset of tuberculosis. Particularly, extra-pulmonary tuberculosis, including disseminated tuberculosis are often. Tuberculin reaction before receiving infliximab are weak. No one, receiving chemoprophylaxis, has onset of tuberculosis. When the rate of chemoprophylaxis increases, the number of tuberculosis patients decreases. Immunocompromised hosts need to be examined periodical or extraordinary when they had symptoms of tuberculosis to discover the onset of tuberculosis. To prevent the onset of tuberculosis, patients who previously infected tuberculosis should receive active chemoprophylaxis regardless of their age.
我们调查了合并糖尿病、艾滋病、胃切除术、恶性肿瘤或接受抗肿瘤坏死因子-α治疗的结核病患者的临床特征及应对措施。近年来，合并糖尿病的结核病患者数量不断增加。他们的结核病往往在病情晚期才被发现，且症状期较短。简而言之，合并糖尿病的结核病患者病情进展迅速。日本合并艾滋病的结核病患者多见于中年且数量不断增加。艾滋病患者中肺外结核（包括播散性结核）较为常见。随着高效抗逆转录病毒治疗（HAART）的普及，他们的预后有所改善。胃切除术最常见的原因是胃癌，且预后良好。其中许多患者体型消瘦且营养不良。合并恶性肿瘤的结核病患者预后较差，尤其是合并肺癌和恶性淋巴瘤的患者。接受抗肿瘤坏死因子-α药物英夫利昔单抗治疗的人经常会发生结核病。特别是肺外结核，包括播散性结核较为常见。接受英夫利昔单抗治疗前结核菌素反应较弱。接受化学预防的人无人发生结核病。当化学预防的比例增加时，结核病患者数量会减少。免疫功能低下的宿主在出现结核病症状时需要定期或格外进行检查，以便发现结核病的发病情况。为预防结核病的发生，既往感染过结核的患者无论年龄大小均应接受积极的化学预防。
