南部兩醫院肺結核病人之預後比較和存活因子預測

背景: 在都治計劃(DOTs)全國實施後，在高齡化社會中，肺結核(Tuberculosis) (TB )在年老者發生率越來越高，所以基層醫療場所對於肺結核的診斷和治療是項值得令人探討的問題。研究目的: 利用肺結核個案管理資料，使用回溯性研究，分析不同醫院就醫人口差異，討論痰液檢查正確性，探討用藥副作用和預測存活影響因子以及醫療資源耗用的趨勢。研究方法: 方法：收集某區域醫院民國96年~98年登錄肺結核個案管理的新發生病人，以及某醫學中心民國96年~97年登錄肺結核個案的新生病人，去除治療期間轉出不明者，共收集860 病人，利用回溯性研究分析不同醫院的治療藥物副作用、治療結果（含完治、死亡和轉出、改診斷）、並分析某區域醫院肺結核病人的醫療資源耗用趨勢。研究結果: 南部不同地區的醫院肺結核病患平均年齡有差異(區域醫院；61歲/ 醫學中心: 54歲)，治療藥物副作用有明顯差異(p<0.001) ，治療結果有明顯差異(p<0.001)。南部區域醫院在96年、97年及98年肺結核病患共有516名，平均年齡為61.66歲。性別以男性居多，佔62.6%。胸部X光異常有95.9%。痰液抹片陽性率是61.2%。無肺結核家史佔97.5%。肺外結核佔15.1%。有合併症情況佔55.2%，合併症以糖尿病及心血管居多。平均用藥天數是171.8天，有用藥副作用情況佔33.9%，副作用以腸胃不適居多。治療結果完治佔59.1%，死亡佔11.8%。平均門診次數是7.20次，平均住院天數是16.4天，平均住院費用是105977元。在預測預後因子方面，發現年齡和體重是重要預後影響因子，尤其當年齡大於75歲和體重低於55公斤有明顯統計上意義。結論和建議；台灣肺結核病患發生率和治癒率雖有下降，但在年老者治癒率的部份仍需值得探討必要，且肺結核病患在高齡化社會發生率偏高，因此預後情形及治療結果，治療費用和預後因子分析，是一項值得關切的問題。

關鍵字

肺結核；痰檢查；年齡；體重；醫院；醫療費用

並列摘要

Background: Under the proposal of day observation therapy (DOTs) in the whole country, pulmonary tuberculosis (TB) has the higher prevalence by the way of the aging community. So the outcome of pulmonary tuberculosis in primary health care institution is worth exploring in depth. Purpose: According to local data of tuberculosis case management, we analyze the patient difference and sputum sensitivity in 2 different hospital and we analyze the outcome and predictive factor in the regional hospital. Method: Collect the fresh case of regional hospital from 2007 to 2009 and the fresh case of medical center from 2008 to 2009 , via the local data of tuberculosis case management. The total case is 860 patients. We are used to analyze the outcome and medical cost trend retrospectively in the different hospital care. Result: In the different hospital care, the average age of the tuberculosis patient has the statistical difference( the average age in regional hospital: 61 year-old/ medical center:54 year-old). The complications of anti-tuberculosis between the 2 different hospital has the statistical difference. (p<0.001). The outcome of tuberculosis therapy has also too.(p<0.001). There are the total 516 case within the regional hospital from 2007 to 2009. The average age is 61.66 year-old. The ratio of male /female is 62.6%/37.4%. The rate of abnormal radiology finding in chest is about 95.9%, vary high. The positive rate of sputum smear is 61.2%. Total negative rate of family history in pulmonary tuberculosis is highly 97.5%. The case of extra-pulomary lesion is totally 15.1%. The comorbidity of the total case is 55.2%, predominantly in the diabetics and cardiovascular disease. The average length of treatment is 171.8 days and the rate of complications totally is 33.9%, predominantly in the gastroenteral upset. The outcome of cure is totally 59.1% and the outcome of death is 11.8%. The average clinical visit is 7.2 and the length of stay in the hospital is 16.4 days. The average of medical cost in hospitalization is 1’5977 NT dollars. In the predictive analysis, the age and the body weight is the independent risk factor of the outcome, especially statistically difference when the age more than 75 and the BW low than 55 kilogram. Conclusion and suggestion: The prevalence and cure rate in tuberculosis got low in the past , but we still got low in WHO goal. In the ongoing of aging society, the prevalence of the tuberculosis will be increased , so we must take more care in the outcome and medical cost and get more advantage in the pulblic health.