643例老年肺结核病的临床分析

Clinical analysis of 643 elderly pulmonary tuberculosis

目的探讨近年来老年肺结核病的临床特点,以期提高老年肺结核病的诊治水平。方法回顾性分析解放军第三○九医院收治的643例老年肺结核患者的肺结核分型、合并疾病、痰或支气管肺泡灌洗液(BALF)中抗酸杆菌(AFB)、临床表现、影像特点、治疗结果及抗结核化疗的不良反应情况。结果643例患者中,继发性肺结核占93.9%(604/643),血行播散性肺结核占6.1%(39/643),原发性肺结核0例;总AFB阳性率为31.9%(205/643)。症状以咳嗽(514/643,79.9%)、发热(369/643,57.4%)为主,AFB阳性者咳嗽率(87.8%,180/205)高于AFB阴性者(76.3%,334/438)(χ2=11.614,P=0.001),AFB阴性者盗汗率(32.9%,144/438)高于AFB阳性者(24.4%,50/205)(χ2=4.774,P=0.029)。所有患者中89.6%(576/643)的患者合并其他内科疾病,其中78.1%(450/576)合并2种及2种以上疾病,所有患者中以肺部感染最为常见,达51.2%(329/643);菌阳者肺部感染率(57.1%,117/205)高于菌阴者(48.4%,212/438)(χ2=4.202,P=0.040),女性患者(19.7%,37/188)较男性更多合并高血压(13.2%,60/455)(χ2=4.380,P=0.036)。604例继发性肺结核患者肺部病灶以浸润、坏死为主,无空洞患者病灶分布以多肺区为主(41.4%,250/604)。AFB阳性者住院期间痰菌阴转率为59.5%(122/205),治疗总有效率为87.1%(560/643),住院病死率5.1%(33/643)。抗结核治疗不良反应以肝损害为主,占6.4%(41/643)。结论643例老年肺结核症状以咳嗽、发热为主;病灶以多肺区为主;合并其他内科疾病几率高,并以肺部感染为首;老年肺结核的治疗应个体化。

Objective We analyzed the clinical characteristics of elderly pulmonary tuberculosis（TB） in order to improve the diagnosis and treatment of this disease. Methods We retrospectively analyzed their clinical presentation,radiological features,sputum（or BALF） AFB,underlying diseases,anti-TB adverse effects and the responses to anti-TB chemotherapy among 643 hospitalized elderly cases with pulmonary tuberculosis in the 309th hospital. Results This group had 93.9%（604/643） secondary tuberculosis,6.1%（39/643） hematogenous dissemination,and no primary tuberculosis.The rate of the positive AFB including smear and culture from both sputum and BALF together was 31.9%（205/643）.Coughing was the most common symptom（79.9%,514/643） which appeared more often in the positive AFB cases than that in the negatives（87.8% vs.76.3%;χ2=11.614,P=0.001）.On the other hand,night-sweat appeared more common in the negatives（32.9% vs.24.4%;χ2=4.774,P=0.029）.Almost 90% of them had underlying diseases,78.1%（450/576） had at least two kinds.The most common disease was pneumonia（51.2%,329/643） which was more popular in the positive AFB cases than in the negatives（57.1% vs.48.4%;χ2=4.202,P=0.040）.The hypertension was more common in females than in males（19.7% vs.13.2%;χ2=4.380,P=0.036）.Infiltration and necrosis were more common imaging in 604 case with secondary tuberculosis and multiple lung fields were involved（41.4%,250/604）.59.5%（122/205） of them became sputum conversion negative after treatment during the hospitalization.The effective rate of this short-term chemotherapy was 87.1%（560/643）,and the mortality rate was 5.1%（33/643）.The most prevalent adverse effects of anti-TB chemotherapy were liver toxicity（6.4%,41/643）. Conclusion The elderly pulmonary tuberculosis presented more with coughing,fever,some underlying diseases including the pneumonia as the top one.Their pulmonary focuses were characteristic with distributing in one more lung fields.Elderly pulmonary tuberculosis should be given personalized treatment.