結核入院期間を決定する要因に関する臨床疫学的研究  [in Japanese] EPIDEMIOLOGICAL STUDY ON FACTORS AFFECTING THE HOSPITALIZATION PERIOD OF PATIENTS WITH ACTIVE TUBERCULOSIS  [in Japanese]

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Author(s)

    • 藤野 忠彦 FUJINO Tadahiko
    • 独立行政法人国立病院機構神奈川病院呼吸器科 Departments of Respiratory Diseases, National Hospital Organization (NHO) Kanagawa National Hospital
    • 布施川 久恵 FUSEGAWA Hisae
    • 独立行政法人国立病院機構神奈川病院呼吸器科 Departments of Respiratory Diseases, National Hospital Organization (NHO) Kanagawa National Hospital
    • 西海 麻依 [他] NISHIUMI Mai
    • 独立行政法人国立病院機構神奈川病院呼吸器科 Departments of Respiratory Diseases, National Hospital Organization (NHO) Kanagawa National Hospital
    • 大久保 泰之 OKUBO Yasuyuki
    • 独立行政法人国立病院機構神奈川病院呼吸器科 Departments of Respiratory Diseases, National Hospital Organization (NHO) Kanagawa National Hospital
    • 柿崎 徹 KAKIZAKI Toru
    • 独立行政法人国立病院機構神奈川病院呼吸器科 Departments of Respiratory Diseases, National Hospital Organization (NHO) Kanagawa National Hospital
    • 前島 潔 MAEJIMA Kiyoshi
    • 独立行政法人国立病院機構神奈川病院内科 Internal Medicine, National Hospital Organization (NHO) Kanagawa National Hospital
    • 杉森 裕樹 SUGIMORI Hiroki
    • 大東文化大学スポーツ・健康科学部健康科学科 Department of Sports and Health Science, Daito Bunka University

Abstract

〔目的〕結核症例の排菌停止までの期間を調べ,入院期間を決定する要因について検討を行った。〔研究対象〕1996年1月1日より2003年12月31日までの8年間に,旧国立療養所神奈川病院(現,独立行政法人国立病院機構神奈川病院)結核病棟に入院した確実診断例1260例を研究対象とした。〔結果〕入院時大量排菌例(塗抹検査G9~10)の排菌停止までの期間は3カ月(median),[3.9カ月(mean)],培養3+の時には2カ月(median),[2.8カ月(mean)]であった。学会分類I+II3では3カ月(median),[2.8カ月(mean)]であった。薬剤感受性試験で何らかの薬剤に耐性を示す時には2カ月(median),[2.2カ月(mean)],多剤耐性では4カ月(median),[5カ月(mean)]であった。年齢,性別を調整した多重比例ハザードモデルに基づく退院エンドポイントに対する要因別では性別,慢性腎不全,アルコール依存症の合併を除く他の要因はすべて有意差を認め,とりわけ入院時塗抹,培養排菌量,薬剤感受性試験成績,胸部X線上の空洞病変は関与の強い要因であった。〔考案ならびに結論〕入院時大量排菌例,薬剤耐性例,空洞病変のある時には,排菌停止までに2カ月以上を要する。結核撲滅のゴールに到達するためには適切な治療を行って,感染源となる症例を1例でも減らしていくことである。今日結核入院にも「在院日数短縮」の考えが取り入れられているが,結核入院の目的のひとつである「感染性の回避」のためにも,入院期間は慎重に決定されるべきである。

[Objective] We compared the time needed for sputum negative conversion of tubercle bacilli among patients with active tuberculosis to clarify factors affecting the hospitalization period.<BR>[Subjec ts and Methods] We retrospectively reviewed 1260patients definitely diagnosed as active tuberculosis between Jan.1996 and Dec.2003. Smears were examined by fluorescent staining procedure, and cultures were tested by egg-based Ogawa and Kudo-PD solid media. Sputum smears and cultures were examined at least once a month. All patients received standard chemotherapy including isoniazid (INH), rifampicin (RFP), ethambutol hydrochloride (EB) [or streptomycin sulfate (SM)], and pyrazinamide (PZA). Time needed for sputum conversion was defined as the period from the initiation of chemotherapy to the first documented negative smear and culture. Multivariate analysis was performed to document factors that were independently associated with hospitalization period.<BR>[Results] Factors correlated with longer conversion time were high amount of bacilli discharge, severe radiographic findings, and drug sensitivity at the initiation of treatment. Patients with bacilli discharge Gaffky 9-10 required 3 months (median) [3.9 months (mean)], and those with culture 3 +required 2 months (median) [2.8 months (mean)] for conversion. Patients with large and widespread cavities, classified as I or II 3 according to the Classification by the Japanese Society for Tuberculosis, required conversion time of 3months (median) [2.8 months (mean)]. Cases with initial drug resistance to any of the drugs required 2 months (median)[2.2 months (mean)] for conversion. Factors associated with prolongation of hospitalization were the amount of bacilli in sputum at the initiation of chemotherapy, past history of tuberculosis, presence of cavities and size of lesion observed on chest X-ray, drug resistance, and presence of extra-pulmonary lesions. Gender, complication with chronic renal failure, and alcoholism did not affect the hospitalization period.<BR>[Conclusion] Patients with huge amount of bacilli discharge, extensive cavitary lesion, or initial drug resistance required more than 2 months for sputum negative conversion. In these cases, hospitalization period shorter than 2 months is inadequate, even if chemotherapy is initiated. For complete eradication of tuberculosis, we must ensure adequate chemotherapy and hospitalization period to eliminate further sources of infection. Our study shows that hospitalization period should be cautiously determined based on the disappearance of bacilli in sputum.

Journal

  • Kekkaku(Tuberculosis)

    Kekkaku(Tuberculosis) 83(8), 567-572, 2008-08-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

References:  16

Cited by:  4

Codes

  • NII Article ID (NAID)
    10025688852
  • NII NACSIS-CAT ID (NCID)
    AN00073442
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00229776
  • NDL Article ID
    9616645
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-133
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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