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長崎医療センターにおける過去4年間の入院中患者の結核発生状況と診断の遅れについての検討


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Title: 長崎医療センターにおける過去4年間の入院中患者の結核発生状況と診断の遅れについての検討
Other Titles: INCIDENCE OF TUBERCULOSIS AND EVALUATION OF DIAGNOSTIC DELAY IN ADMITTED PATIENTS DURING PAST FOUR YEARS AT NATIONAL HOSPITAL ORGANIZATION NAGASAKI MEDICAL CENTER
Authors: 山本, 和子 / 大角, 光彦 / 木下, 明敏 / 松岡, 陽治郎 / 柳原, 克紀 / 崎戸, 修 / 井上, 祐一 / 福島, 喜代康 / 米倉, 正大 / 河野, 茂
Authors (alternative): Yamamoto, Kazuko / Osumi, Mitsuhiko / Kinoshita, Akitoshi / Matsuoka, Yohjiro / Yanagihara, Katsunori / Sakito, Osamu / Inoue, Yuichi / Fukushima, Kiyoyasu / Yonekura, Masahiro / Kohno, Shigeru
Issue Date: Jun-2008
Citation: 医療, 62(6), pp.323-330; 2008
Abstract: 結核病棟が廃止され30年が経過する当総合病院入院患者における結核発生状況を調査した。1999年1月~2002年12月の4年間に当院で喀痰その他の臨床検体から塗抹, 培養, 核酸増幅検査で結核菌が検出された37症例を対象とした。肺結核と肺外結核に分類し, 特に肺結核の患者背景因子と診断に要した日数について検討した。対象は男性27例, 女性10例。年齢は30~86歳で65歳以上が全体の76%を占めた。肺結核の既往を14例に認め, 基礎疾患は悪性腫瘍, 呼吸器疾患, 循環器疾患, 糖尿病の順に多かった。うち肺結核患者29例は平均年齢69.1歳, 男性22例, 女性7例であった。肺結核のX線学会分類では、Ⅰ+II型 17.1 %, III+IV型 82.7 %と有空洞例が少なかった。肺結核診断に1ヶ月以上要したのは11例(37.9%)であった。塗抹陰性例の検討では,核酸増幅検査陽性群で有意差をもって(p=0.012)核酸増幅検査陰性/未検査群に比し早期に診断されていた。診断が遅れた原因は主治医が結核を疑わなかった場合と培養検査に長期間要した場合の2つに大別された。前者への対策として, 高齢者や既結核感染患者, 免疫不全状態のハイリスク患者には結核を常に念頭に置き積極的に抗酸菌検査を行うよう、啓発する。 後者については近年導入された液体培地やクオンティフェロンなどの新しい検査法を用いることが早期診断につながる可能性が期待される。結核二次感染を防ぐためには, 個々の医師への啓発に加え, 院内感染対策チームや呼吸器内科医が効率的に結核診療へ介入できるシステム構築が重要である。 / We retrospectively evaluated clinical characteristics of 41 admitted patients who diagnosed as tuberculosis by results from Ziel-Nielsen smear test and/or culture test and/or ligase chain reaction (LCR) method, from January 1999 to December 2002 at National Organization Nagasaki Medical Center in Japan. We also analyzed delay of diagnosis (Diagnostic delay: which means duration required for diagnosis after patient’s symptom had appeared) especially in cases with pulmonary tuberculosis. Twenty-eight patients were male and 13 patients were female. Twenty-eight out of 37 patients were of elder age-groups (mean age, 68.4 years; range, 30~86 years). Twenty-nine patients diagnosed as pulmonary tuberculosis, 28 of them were male, and remaining 13 of them were female. Fourteen patients had a past history of pulmonary tuberculosis. Details of underlying diseases in patients with pulmonary tuberculosis were, malignant disease in 10 patients, other pulmonary diseases in 7 patients, cardiovascular diseases in 7 patients, diabetes mellitus in 5 patients, and so on. Total of 82.7% patients classified as non-cavity type on chest X-ray films for pulmonary tuberculosis. Eleven patients (37.9%) required diagnostic delay of over than one month. Smear-negative pulmonary lung tuberculosis with LCR-positive group were diagnosed significantly early (p=0.012) compared to LCR-negative and/or LCR-not examined group. The reasons for late diagnosis were differentiated in two types. First, doctors didn’t suspect of pulmonary tuberculosis; or second, results of microbiological examinations were delayed. To improve these situations, doctors should constructively examine pulmonary tuberculosis when patients are in elder age-groups and /or have past history of pulmonary tuberculosis, and/or under immuno-compromised diseases. Further, using new diagnostic method such as broth culture technique or IFN- assay with high sensitivity may lead early diagnosis of tuberculosis. Enlightenment of tuberculosis in general hospital is necessary for avoiding secondary nosocomial infection, with infection control doctors and doctors who belong to respirology as a leader.
Keywords: Pulmonary tuberculosis / General hospital patients / Diagnostic delay
URI: http://hdl.handle.net/10069/23087
ISSN: 00211699
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/23087

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