血液透析患者における結核発病の現状  [in Japanese] TUBERCULOSIS IN THE PATIENTS UNDERGOING HAEMODIALYSIS IN JAPAN, 1996  [in Japanese]

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Abstract

過去の報告において結核発病リスクが高いとされた血液透析患者における現在の結核発病リスクについて, 本邦の血液透析施設に1996年の血液透析患者を対象としてアンケート調査を行い検討した. 観察された患者数 (O) に対する期待患者数 (E) を算出し, 標準化発病者比 (O/E比) を求めたが, 全結核では, 男性1.55, 女性2.79, 合計1.99であり, 血液透析患者における結核発病は一般人口と比較し有意に高率であった. 肺結核では, O/E比は男性1.01, 女性1.40, 合計1.16, 菌陽性肺結核では, O/E比は男性0.96, 女性0.80, 合計0.97であり, 血液透析患者における肺結核発病は一般人口と比較し有意のリスクを認めなかった. 肺外結核では, O/E比は男性13.45, 女性13.07, 合計12.97であり, 血液透析患者における結核発病は一般人口と比較し有意に高率であったが, 過去の報告と比較し低下していた. 結核発病は過去の報告より低下していたが, 免疫抑制宿主であり容易に院内感染を生じること, 肺結核, 結核性胸膜炎については予後が不良であったことから, 血液透析患者の結核発病については検討をさらに継続していく必要があると考えられた.

We conducted a questionnaire survey on patients undergoing haemodialysis about the present situation of tuberculous incidence. They are immunocompromised hosts and are said to be at high risk of developing tuberculosis in many reports.<BR>(1) Design<BR>Of the 167, 192 patients on haemodialysis registered on December 31, 1996 in Japan, 71, 411 patients were available for the questionnaire survey. Of the 2, 893 hospitals used as the study subjects, 1, 108 hospitals gave satisfactory replies. Of them, 141 hospitals reported that they had patients with tuberculosis in 1996, and 79 cases were collected by the detailed survey on tuberculosis patients conducted later. They included 45 male cases, 34 female cases for tuberculosis of all forms, 28 male cases, 15 female cases for pulmonary tuberculosis (PTB), 13 male cases, 4 female cases for tuberculosis bacilli positive pulmonary tuberculosis (TB positive PTB), and 17 male cases, 19 female cases for extrapulmoanry tuberculosis.<BR>(2) Results<BR>In tuberculosis of all forms, the number of observed patients (0) against the number of patients expected (E) was calculated, and the standardized patients ratio (O/E ratio) was computed. It was 1.55 for male, 2.79 for female and 1.99 for total. The incidence of tuberculosis haemodialysis patients was significantly higher compared with the general population (p<0.01). As to PTB, the O/E ratio was 1.01 for male, 1.40 for female and 1.16 for total ; the incidence of PTB was not significantly higher compared with the general population. With TB positive PTB, the O/E ratio was 0.96 for male, 0.80 for female and 0.97 for total, and no significant difference was found. As for extrapulmonary tuberculosis, the O/E ratio was 13.45 for male, 13.07 for female and 12.97 for total; the incidence of extrapulmonary tuberculosis in haemodialysis patients was significantly higher (p<0.01), but it was lower than these reported in the past literature. The seventy nine cases consisted of 52 primary treatment cases, 23 retreatment cases, and 4 unknown cases. Out of 79 cases, 36 cases developed tuberculosis almost at the same time or within 1 year after undergoing haemodialysis, and thereafter it decreased gradually. Underlying diseases for haemodialysis were mainly glomerulonephritis and diabetic nephropathy. There were many patients who failed to notify to the public health centers after the diagnosis of tuberculosis was made, and it is needed to improve such a situation in the future.<BR>The prognosis of tuberculosis undergoing haemodialysis was poor. Three out of 43 patients with PTB and 2 out of 13 tuberculosis pleurisy cases died.<BR>(3) Conclusion<BR>The risk of developing PTB in patients undergoing haemodialysis was not high compared with the general population, however, the risk was much higher for extrapulmonary tuberculosis. Moreover, the treatment outcome was not satisfactory in patients with PTB and pleurisy. As patients undergoing haemodialysis have the factors which suppress the cell-mediated immunity, it is required to restudy the measures to prevent development of tuberculosis, management and treatment in the future.

Journal

  • Kekkaku(Tuberculosis)

    Kekkaku(Tuberculosis) 77(2), 51-59, 2002-02-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

References:  25

Cited by:  17

Codes

  • NII Article ID (NAID)
    10008385092
  • NII NACSIS-CAT ID (NCID)
    AN00073442
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00229776
  • NDL Article ID
    026778775
  • NDL Call No.
    Z19-133
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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