Clinical Characteristics of Pulmonary Tuberculosis Patients from a Southern Taiwan Hospital-Based Survey

以南台灣某醫院為基礎之肺結核病患的臨床特徵調查

王傳生(Chuan-Sheng Wang) ； 陳煌麒(Huang-Chi Chen) ； 楊志仁(Chih-Jen Yang) ； 蔡忠榮(Jong-Rung Tsai) ； 鍾飲文(Inn-Wen Chong) ； 黃吉志(Jhi-Jhu Hwang) ； 黃明賢(Ming-Shyan Huang)

《The Kaohsiung Journal of Medical Sciences》 24卷1期 (2008/01) Pp. 17-24

摘要

這篇研究是要辨別從2003年8月l日至2006年7月31日以南台灣某醫院為基礎之肺結核培養陽性病患的臨床特徵調查。我們記錄人口統計學，症狀，藥物感受性，痰抗酸性細菌染色狀態及治療結果，並且回顧性分析高雄市立小港醫院的154位病患的病歷資料。病患平均年齡＋標準差是59.5±18歲，包括115位男性（佔74.7%）及39位女性（佔25.3%）。糖尿病是肺結核感染最常見的風險因子（佔31.2%）。幾乎所有病患有咳嗽（佔90.3%），發燒只在27.9%的病患可見，另外咳血只佔14.9%。第一線抗結核藥物的綜合抗藥性比率如下：isoniazid、3.2%; rifampin、7.8%；ethambutol、5.8%和streptomycin、2.6%。針對四種第一線抗結核藥物中的任一種的綜合抗藥性比率是12.3%。針對ofloxacin的綜合抗藥性比率是3.9%。多重抗藥性結核的綜合抗藥性比率是1.9%。病患呈痰抗酸性細菌染色陽性有68.2%。對治療結果的分析顯示，整體治療成功率達76.6%，病患死亡、治療失落及治療失敗的比率各佔16.2%，3.9%和0.0%。總而言之，我們的研究顯示，(1)比臺灣其它地區的肺結核患者，男性佔更高的比率。(2)比先前的研究，有更高的比率咳嗽，更低的比率發燒和咳血。(3)對isoniazid和streptomycin綜合抗藥性比率，比臺灣的平均水準和全球性低；對ethambutol綜合抗藥性比率，與臺灣的平均水準是相似的，但比全球性高；但是，對rifampin綜合抗藥性比率，比臺灣的平均水準和全球性高；針對四種第一線抗結核藥物中之任一種的綜合抗藥性比率和多重抗藥性結核的綜合抗藥性比率，比臺灣的平均水準低，但比全球性高。(4)比臺灣其它地區的肺結核患者，有更高的比率治療成功，更低的比率死亡、治療失落及治療失敗。這些結論可以幫助辨別疾病的本土性的差異及改進結核病感染控制計劃的成效。

關鍵字

肺結核 ； 抗藥性 ； 症狀 ； 台灣 ； 治療結果

並列摘要

This study aimed to identify the clinical characteristics of culture-positive pulmonary tuberculosis (TB) patients from a southern Taiwan hospital-based survey between August 1, 2003 and July 31, 2006. Demographics, symptoms, susceptibility patterns, sputum acid-fast bacilli (AFB) stain status and treatment outcomes were recorded. The medical records of 154 patients who presented to the Kaohsiung Municipal Hsiao-Kang Hospital were analyzed retrospectively. The mean age of patients was 59.5 years; 115 patients were male and 39 were female. Diabetes mellitus (48/154; 31.2%) was the most frequent risk factor for pulmonary TB infection. Nearly all patients (139/154; 90.3%) had a cough. Fever was only seen in 27.9% and hemoptysis in 14.9% of patients. The combined resistance rates of Mycobacterium tuberculosis to the tested first-line agents were as follows: isoniazid, 3.2%; rifampin, 7.8%; ethambutol, 5.8%; and streptomycin, 2.6%. The combined resistance rate to any one of four first-line drugs was 12.3%. The combined resistance rate to ofloxacin was 3.9%. The combined resistance rate of multidrug resistant-TB was 1.9%. Sputum AFB stains were positive in 68.2% of cases. Analysis of treatment outcomes showed overall treatment success at 76.6%. The proportions of patients who died, defaulted treatment or in whom treatment failed were 16.2%, 3.9% and 0.0%, respectively. In conclusion, our study showed: (1) a higher frequency of pulmonary TB in male subjects than in other areas of Taiwan; (2) a higher frequency of cough and lower frequency of fever and hemoptysis than previous studies; (3) that the combined resistance rates to isoniazid and streptomycin were lower than both average levels in Taiwan and the global combined drug resistance rate; and (4) a higher proportion of patients responding to treatment and lower proportions of patients suffering mortality, defaulting treatment or not responding to treatment compared with other areas of Taiwan. With regard to resistance rates, the combined resistance rate to ethambutol was similar to the average level in Taiwan and higher than the global combined drug resistance rate. However, the combined resistance rate to rifampin was higher than both the average level in Taiwan and the global combined drug resistance rate. The combined resistance rates to at least any one of four first-line drugs and multidrug resistant-TB were lower than the average levels in Taiwan and higher than the global combined drug resistance rate. Our results may help to identify local variations in the disease and improve the effectiveness of TB infection control programs.

並列關鍵字

pulmonary tuberculosis ； resistance ； symptom ； Taiwan ； treatment outcome