Case Fatality Rate of Tuberculosis Patients in a Community Hospital in Taiwan, 2003-2008

2003-2008年臺灣一社區型醫院結核病人死亡之危險因子分析

詹雲翔(Yun-Hsiang Chan) ； 楊靖慧(Chin-Hui Yang) ； 陳寬榮(Kuan-Jung Chen)

《胸腔醫學》 26卷2期 (2011/04) Pp. 62-72

https://doi.org/10.29806/TM.201104.0001

摘要

前言：分析臺灣一社區型醫院結核病人死亡之危險因子。
方法：此為一回溯性研究，對象為台北市立聯合醫院仁愛院區自2003年到2008年間223位細菌學確診之結核病人，由病歷收集其背景資料、臨床病程、治療結果與HIV檢測情形。使用Cox回歸分析方法來決定與結核病死亡相關之危險因子。
結果：超過一半以上之病人年紀超過65歲。整體的結核病致死率為29.6%（66例），其中只有21.2%的死亡可直接歸因於結核病相關。糖尿病是最常見的原在性疾病，但是肝硬化病人有最高之結核病致死率。各種可能的預後因子中只有病人的年齡與肝硬化對與死亡預後有明顯相關。只有28位病人(21%)有檢查HIV，但從其中發現了3個新的HIV感染病。
結論：有很高比例的結核病人為年老且合併各種潛在性疾病，因此增加了結核病治療的致死率，但是近八成的死因為非結核相關因素。因此，針對具有高危險因子的病人，增強臨床診治能力以及預防結核病發病的相關政策有助於降低結核病致死率。此外，針對結核病人的HIV檢驗普及率很低，需要有更積極的方式來推行此政策。

關鍵字

結核病 ； 致死率 ； HIV檢驗 ； 肝硬化 ； 年長者

並列摘要

Background: This study aimed to identify the possible risk factors associated with the fatality rate of tuberculosis (TB) patients in a community hospital in Taiwan.
Methods: This is a retrospective review of 223 bacteriology-confirmed TB cases in the Ren-Ai Branch of Taipei City Hospital, Taiwan from 2003 to 2008. Demographic and clinical data, treatment outcomes, and HIV testing information were collected through medical records. Cox regression analysis was used to determine independent risk factors for death.
Results: Over one-half of the patients were aged ＞65 years. The overall fatality rate was 29.6% (66 cases), of which only 21.2% were TB-related. DM was the most frequent co-morbidity, but liver cirrhosis had the highest fatality. Old age and liver cirrhosis were independent risk factors for fatality in TB patients. Only 28 patients (12.6%) had HIV testing and 3 new HIV infections were identified.
Conclusions: The high proportion of co-morbidity among the elderly TB patients increased the risk of fatality. Around 80% of deaths were non-TB-related. Improved clinical management and prevention strategies for high-risk populations are important to reduce TB fatality. The frequency of HIV testing among TB patients is relatively low and more aggressive promotion is necessary.

並列關鍵字

tuberculosis ； fatality ； HIV testing ； liver cirrhosis ； elderly