Davis C E, Carpenter J L, McAllister C K, Matthews J, Bush B A, Ognibene A J
Chest. 1985 Nov;88(5):726-9. doi: 10.1378/chest.88.5.726.
A five-year review (1979 to 1983) of 41 patients with active tuberculosis at the time of death was performed to determine the cause of death. Twenty deaths (49 percent) were directly attributed to tuberculosis. Overwhelming tuberculous disease was the cause of death for seven patients, and among them the majority had strikingly low serum levels of albumin. Ten patients died of either massive hemoptysis or respiratory failure. Only two patients died due to progressive drug-resistant disease in an area where drug resistance is common. The majority of patients (21/41; 51 percent) died of common medical problems unrelated to tuberculosis. Eleven patients died from cardiopulmonary disease (five pulmonary emboli, one respiratory failure due to chronic obstructive pulmonary disease, two acute myocardial infarctions, and two primary dysrhythmias). Three deaths were the result of gastrointestinal bleeding, and three patients died as a result of bacterial superinfection. Our data indicate that patients still die of tuberculosis in the era of effective antituberculosis therapy. It is imperative that clinicians are aware that pulmonary emboli, arteriosclerotic heart disease, bacterial superinfection, and gastrointestinal bleeding cause approximately 50 percent of the deaths among patients who have tuberculosis and that prompt recognition and treatment of those diseases might decrease the mortality from tuberculosis.
对41例死亡时患有活动性肺结核的患者进行了一项为期五年（1979年至1983年）的回顾性研究，以确定其死因。20例死亡（49%）直接归因于肺结核。7例患者死于严重的结核病，其中大多数患者血清白蛋白水平极低。10例患者死于大咯血或呼吸衰竭。在耐药情况普遍的地区，只有2例患者死于进展性耐药疾病。大多数患者（21/41；51%）死于与肺结核无关的常见医疗问题。11例患者死于心肺疾病（5例肺栓塞、1例慢性阻塞性肺疾病导致的呼吸衰竭、2例急性心肌梗死和2例原发性心律失常）。3例死亡是胃肠道出血的结果，3例患者死于细菌重叠感染。我们的数据表明，在有效的抗结核治疗时代，患者仍死于肺结核。临床医生必须意识到，肺栓塞、动脉硬化性心脏病、细菌重叠感染和胃肠道出血导致了约50%的肺结核患者死亡，及时识别和治疗这些疾病可能会降低肺结核的死亡率。
