Impact of Age and Diabetes on the Chest Radiography Presentation of Patients with Pulmonary Tuberculosis

年齡與糖尿病對肺結核病人胸部X光表徵的影響

陳柏崇(Po-Chung Chen) ； 王東衡(Tung-Heng Wang) ； 陳九五(Ju-Wo Chen) ； 黃吉志(Jhi-Jhu Hwang) ； 黃明賢(Ming-Shyan Huang)

《胸腔醫學》 18卷4期 (2003/08) Pp. 322-328

https://doi.org/10.29806/TM.200308.0003

摘要

背景：肺結核仍是台灣最嚴重的傳染病之一。胸部X光是診斷肺結核重要的工具，然而病人的年齡及潛在疾病常常會影響其胸部X光的表現，而潛在疾病中又以糖尿病的影響最大。本研究探討年齡與糖尿病對肺結病人胸部X光表徵的影響。
方法：我們回溯收集從西元2001年1月至西元2002年6月間，由高雄醫學大學附設中和紀念醫院診斷為肺結核的病人，總計242位。依據糖尿病有無，分為有糖尿病及非糖尿病兩組。年齡小於45歲為年輕病人，年齡大於65歲為年老病人。根據五種不同胸部X光病灶：只有上肺區、只有下肺區、合併上下肺區、開洞及肋膜積水，進行分析。
結果：有68位病人合併有糖尿病，174位病人為非糖尿病組。研究發現在診斷方法中的耐酸性痰液檢查，糖尿病組明顯較高陽性率。在胸部X光的比較上，兩組在只有上肺區、只有下肺區及合併上下肺區並無顯著差別，但在空洞病灶方面，糖尿病組顯著較多。此外，有53位為年輕病人，106位為老年病人。本研究發現老年病人顯著有較複雜的多肺葉侵犯，而年輕病人顯著有較高耐酸性痰液陽性率及較多的空洞病灶。
結論：年齡與糖尿病都會改變肺結核病人胸部X的表徵，因此我們建議醫療人員應了解肺結核在疾病表現上的多變性，尤其在面對老年人集合並有糖尿病的病人，要有高度的懷疑心。

關鍵字

肺結核 ； 年齡 ； 糖尿病

並列摘要

Background: Many factors can affect the chest radiographs of pulmonary tuberculosis (TB) patients. The aim of this study was to evaluate the impact of age and diabetes on the chest radiographs of these patients.
Methods: We retrospectively reviewed 242 patients with the diagnosis of pulmonary tuberculosis, between January 2001 and June 2002, at Kaohsiung Medical University, Chung-Ho Memorial Hospital. Depending on whether or not the subjects had diabetes mellitus (DM), we separated them into two groups: the DM- TB group and the non DM-TB group. We also separated the subjects based on their age: younger patients (aged 45 or less) and elderly patients (aged 65 or more). Five different chest radiographs, including upper lung field only, lower lung field only, upper and lower lung field, cavitation, and pleural effusion, were analyzed.
Results: A total of 68 patients were included in the DM-TB group. We found that the patients with diabetes had significantly more positive sputum acid-fast bacilli and more cavitary lesions on their chest radiographies. A total of 53 patients were placed in the younger group and 106 patients were included in the elderly group. The elderly patients had significantly more multiple lung-field involvement. The younger patients had a significantly higher ratio of positive acid-fast sputum smear, and more cavitary lesions.
Conclusion: Age and DM can alter the chest radiographic presentation of patients with pulmonary tuberculosis. We suggest that physicians need to have a high degree of suspicion and an awareness of the varied manifestations of tuberculosis, especially in elderly and diabetic patients.

並列關鍵字

pulmonary tuberculosis ； age ； diabetes mellitus ； chest radiography