Tsai S Y, Huang M S, Hwang J J, Tsai M S, Wang T H, Lin M S, Chong I W
Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi. 1991 Mar;7(3):107-14.
Pulmonary tuberculosis remains a significant clinical and public health problem in the elderly population. To describe age-related differences in disease manifestations, a comparison of the clinical features, predisposing factors, diagnostic approaches and radiographic findings in cases of pulmonary tuberculosis among 52 young and 62 elderly patients was performed. The elderly patients had a higher number of underlying disease than younger patients (p less than 0.05). Prior to admission, symptoms occurring with equal frequency in both younger and elderly patients included coughing, malaise, and weight loss. Elderly patients had significantly higher incidences of negative reactions to the PPD test (p less than 0.05). Radiographic findings revealed that upper lung field infiltrates were still common in both groups, but the elderly had more severe lung field involvement (two or more lobes affected), and more frequent pleural reactions than younger patients (p less than 0.05). Since there were non-specific clinical features, false negative skin test and complex radiographic manifestations, tuberculosis was frequently not suspected in the differential diagnosis, especially among elderly patients with multiple medical problems. We suggest that physicians need to have a high level of suspicion and awareness of varied manifestations for tuberculosis, especially elderly patients.
肺结核在老年人群中仍然是一个重要的临床和公共卫生问题。为了描述疾病表现的年龄相关差异，对52例年轻患者和62例老年患者的肺结核病例的临床特征、易感因素、诊断方法和影像学表现进行了比较。老年患者的基础疾病数量比年轻患者多（p<0.05）。入院前，年轻患者和老年患者中出现频率相同的症状包括咳嗽、不适和体重减轻。老年患者对PPD试验阴性反应的发生率显著更高（p<0.05）。影像学表现显示，两组上肺野浸润仍然常见，但老年患者的肺野受累更严重（两个或更多肺叶受累），且胸膜反应比年轻患者更频繁（p<0.05）。由于存在非特异性临床特征、皮肤试验假阴性和复杂的影像学表现，在鉴别诊断中经常不怀疑肺结核，尤其是在患有多种疾病的老年患者中。我们建议医生需要对肺结核的各种表现有高度的怀疑和认识，尤其是老年患者。
