透析患者における肺外結核症の疫学的検討

抄録

Suppressed natural defense may predispose uremic patients to the development of extrapulmonary tuberculosis. In order to clarify this problem in patients receiving dialysis, I made an epidemiological study. The subjects were 2034 dialysis patients in 1976 and 2403 dialysis patients in 1977. Among them 30 males and 32 females had extrapulmonary tubercular lesions.
Prevalence, incidence, mean duration of the disease, mortality and fatality of extrapulmonary tuberculosis in the dialysis patients were 621/10⁵, 543/10⁵, 1.1 year, 155/10⁵ and 29% in male and 1340/10⁵, 1475/10⁵, 0.9 year, 402/10⁵ and 27% in female, respectively. The prevalence, incidence, mortality and fatality were 24, 54, 310 and 5.8 times higher in male, and 52, 98, 804 and 9 times higher in female than those in the general population, respectively. The mean duration of the disease was shorter in dialysis patients: 1/2 in male and 1/3 in female of those in the general population.
Extrapulmonary tuberculosis occupied 33% in male and 56% in female of all tuberculosis among dialysis patients on Jun. 30, 1976, whereas it was 3.7% in male and 10% in female in the general population. Extrapulmonary tuberculosis occupied 37% in male and 65% in female of all tuberculosis developed during 1976 among the dialysis patients in contrast to 6.7% in male and 18% in female in the general population. Extrapulmonary tuberculosis occupied 50% in male and 100% in female of all deaths from tuberculosis in dialysis patients, which were much higher than 2.9% in male and 8.8% in female in the general population.
Thus, for the first time, an extremely high susceptibility and low resistance to extrapulmonary tuberculosis and the shorter course of the disease were proved epidemiologically in dialysis patients who were known to have the immunodeficiency. Furthermore, the present study demonstrated a remarkably high frequency of extrapulmonary tuberculosis among all tuberculosis in dialysis patients.