広汎空洞型(bI3)肺結核症例の臨床的検討 A STUDY ON FAR-ADVANCED CAVITARY PULMONARY TUBERCULOSIS CASES
広汎空洞型肺結核 (<I>b</I>I3) 症例を臨床的に検討した。対象は95例, 平均年齢は49.5±13.0歳であった。結核発見動機は, 有症状受診84例, 他疾患管理中10例, 他疾患受診時偶然発見1例で, 全例が喀痰塗抹陽性であった。社会背景として職業は入院時無職31例, 日雇労務者24例, 生活保護受給者25例と, 社会的弱者が多数であった。入院時病状として重症例が多数であり栄養状態は不良であった。当院入院中に死亡した症例は19例 (20.0%) で全例男性であり, 結核発見動機は全例有症状受診で, 入院から死亡までの期間 (在院日数) は35.0±39.8日と短期であった。有症状受診例84例の受診の遅れの期間は5.5±5.0カ月であり診断の遅れの期間は0.3±0.9カ月と短期間であった。<I>b</I>I3症例は発見の遅れの長期化により重症化し, 受診の遅れがその大部分を占めた。予後不良であるこの病型が生じないために発見の遅れを短期化するよう多様な予防対策の実施が望まれる。
In cases with far-advanced cavitary pulmonary tuberculosis, the most serious lesions according to the chest X-ray classification by the Japanese Society of Tuberculosis (<I>b</I>I3), their prognosis is believed to be poor due to their emaciated general conditions, and a retrospective clinical study was made on these cases admitted to our hospital.<BR>The subjects consisted of 95 cases, and among them 87 were male and 8 were female, and their mean age was 49.5 ±13.0 years. Eighty four cases were detected by symptomatic visits to clinics, 10 cases during their reatment for other diseases, and 1 case was discovered accidentally. Sputum examination for acid fast bacilli was all smear positive. As to their social background, the majority were occupied by socially vulnerable groups; 31 cases (32.6 %) were jobless on admission, 24 cases (25.3 %) were day laborers, and 25 cases (26.3 %) were receiving poor relief. Regarding their general condition on admission, 40 cases were very serious and they could not stand by themselves, and their nutritional conditions were poor, and 19 cases (20%) died during hospitalization. All of them were male, and they were found by symptomatic visit to clinics. The period from hospital admission to death was short, the average was 35.0±39.8 days, and the median was 11.0 days. Among 84 patients detected by symptomatic visit, the patient's delay was 5.5±5.0 months, while the doctor's delay was 0.3±0.9 months. Major cause of late detection at advanced stage of these cases was patient's delay which caused poor prognosis of these cases, and various measures to shorten the delay in case-detection must be taken.
結核 77(6), 443-448, 2002-06-15