154例老年肺结核患者的发现与治疗转归情况分析

doi:10.19983/j.issn.2096-8493.20220158

摘要/Abstract

摘要：

目的: 分析老年肺结核患者的发现与治疗转归特点,为老年肺结核的防控与诊治工作提供参考。方法: 搜集2010—2020年北京市石景山区疾病预防控制中心结核病防治所就诊并收治的154例老年活动性肺结核患者作为研究对象,查阅并收集相关资料进行分析。结果: 154例老年患者中,低龄者(60~69岁)占46.10%(71/154),中龄者(70~79岁)占33.12%(51/154),高龄者(≥80岁)占20.78%(32/154);被动发现者占81.17%(125/154),主动发现者占18.83%(29/154)。临床症状中,咳嗽、咳痰(68.18%,105/154)发生率最高,其次是乏力(20.13%,31/154)和发热(17.53%,27/154)。病变多累及≥2个肺野(64.94%,100/154),存在空洞者占48.70%(75/154),其中单发空洞占40.91%(63/154),多发空洞占7.79%(12/154)。治疗前病原学阳性率为67.97%(104/153),3个年龄组(低龄、中龄、高龄)病原学阳性的老年患者在疗程结束时痰菌阴转率分别为95.12%(39/41)、83.33%(30/36)、70.37%(19/27),差异有统计学意义(χ²=7.731,P=0.021)。154例老年肺结核患者成功治疗率为86.36%(133/154),3个年龄组[低龄、中龄、高龄分别为95.77%(68/71)、84.31%(43/51)、68.75%(22/32)]比较,差异有统计学意义(χ²=13.951,P=0.001)。结论: 老年肺结核患者以被动发现为主,影像学表现较为复杂,病原学阳性比例高,治疗转归不理想;应加强老年肺结核患者的主动发现工作,特别是定期进行健康检查,降低不良转归比例。

关键词: 结核, 肺, 老年人, 治疗结果

Abstract:

Objective: To analyze and summarize the characteristics of detection and treatment outcome of elderly pulmonary tuberculosis (PTB) patients, so as to provide reference for diagnosis, treatment, prevention and control of PTB among elderly people. Methods: One hundred and fifty-four elderly active PTB patients treated at the Tuberculosis Control and Prevention Institute of Shijingshan District Center for Disease Control and Prevention from 2010 to 2020 were selected as the research objects. Their data were reviewed and analyzed. Results: Among 154 elderly patients, 46.10% (71/154) were relatively young (60-69 years old), 33.12% (51/154) were middle-aged (70-79 years old), and 20.78% (32/154) were older (≥80 years old); 81.17% (125/154) of them were detected passively, and 18.83% (29/154) were detected actively. Among all clinical symptoms, the incidence of cough and expectoration (68.18%, 105/154) was the highest, followed by fatigue (20.13%, 31/154) and fever (17.53%, 27/154). A majority of patients got lesions invaded more than two lung fields (64.94%, 100/154), and the presence of cavities accounted for 48.70% (75/154), of which single cavity accounted for 40.91% (63/154), and multiple cavities accounted for 7.79% (12/154). The etiologically positive rate before treatment was 67.97% (104/153). The sputum negative conversion rate of them in three age groups at the end of the treatment course were 95.12% (39/41), 83.33% (30/36) and 70.37% (19/27), respectively, with statistically significant difference (χ²=7.731, P=0.021). The successful treatment rate of 154 patients was 86.36% (133/154). There was a statistically significant difference among the three age groups (95.77% (68/71), 84.31% (43/51), 68.75% (22/32), χ²=13.951, P=0.001). Conclusion: The elderly PTB patients were mainly detected passively. Their imaging manifestations were complex, the etiologically positive rate was high, and the treatment prognosis was not ideal. We should strengthen the active detection of elderly PTB patients, especially by performing regular health examination, and reduce the proportion of adverse treatment outcomes.

Key words: Tuberculosis, pulmonary, Aged, Treatment outcome

中图分类号:

R521
R81

张亚敬, 姜影, 孙浩, 唐桂琴, 赵莹. 154例老年肺结核患者的发现与治疗转归情况分析[J]. 结核与肺部疾病杂志, 2023, 4(1): 48-53. doi: 10.19983/j.issn.2096-8493.20220158

Zhang Yajing, Jiang Ying, Sun Hao, Tang Guiqin, Zhao Ying. Analysis of detection and treatment prognosis of 154 elderly pulmonary tuberculosis patients[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(1): 48-53. doi: 10.19983/j.issn.2096-8493.20220158

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年龄组	标准化方案		个体化方案		耐药方案		治疗中方案有调整
年龄组	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	例数	百分率(%)
低龄组(71例)	40	56.34	30	42.25	1	1.41	22	30.99
中龄组(51例)	25	49.02	25	49.02	1	1.96	16	31.37
高龄组(32例)	6	18.75	23	71.88	3	9.38	10	31.25
合计(154例)	71	46.10	78	50.65	5	3.25	48	31.17

性别	低龄组	中龄组	高龄组	合计
男性	48(67.61)	25(49.02)	20(62.50)	93(60.39)
女性	23(32.39)	26(50.98)	12(37.50)	61(39.61)
合计	71	51	32	154

年龄组	例数	2个月末阴转	5个月末阴转	疗程结束
年龄组	例数	2个月末阴转	5个月末阴转	阴转	未阴转
低龄组	41	26(63.41)	37(90.24)	39(95.12)	2(4.88)
中龄组	36	22(61.11)	29(80.56)	30(83.33)	6(16.67)
高龄组	27	13(48.15)	19(70.37)	19(70.37)	8(29.63)
合计	104	61(58.65)	85(81.73)	88(84.62)	16(15.38)
χ²值		1.702	4.357	7.731
P值		0.427	0.113	0.021

年龄组	复查例数	明显吸收	吸收	病灶未变	恶化
低龄组	70	40(57.14)	30(42.86)	0(0.00)	0(0.00)
中龄组	49	18(36.73)	29(59.18)	1(2.04)	1(2.04)
高龄组	30	9(30.00)	17(56.67)	1(3.33)	3(10.00)
合计	149	67(44.97)	76(51.01)	2(1.34)	4(2.68)

年龄组	合并糖尿病	合并其他疾病	治愈	完成治疗	成功治疗
低龄组(71例)	27(38.03)	19(26.76)	38(53.52)	30(42.25)	68(95.77)
中龄组(51例)	17(33.33)	21(41.18)	28(54.90)	15(29.41)	43(84.31)
高龄组(32例)	5(15.62)	16(50.00)	16(50.00)	6(18.75)	22(68.75)
合计(154例)	49(31.82)	56(36.36)	82(53.25)	51(33.12)	133(86.36)
χ²值	5.184	5.911	0.194	5.974	13.951
P值	0.075	0.052	0.908	0.050	0.001