透析患者の結核症
第3報肺結核の疫学
1982 年 57 巻 9 号 p. 477-481
詳細
1982 年 57 巻 9 号 p. 477-481
Uremia is a state with diminished immunological responsiveness. For the purpose of evaluatingthe vulnerability of uremic patients to pulmonary tuberculosis, an epidemiological study was done.The subjects were 2034 dialysis patients in 1976 and 2403 dialysis patients in 1977. Among them 42males and 21 females suffered from pulmonary tuberculosis.
Prevalence, incidence, mean duration of the disease, mortality and fatality of pulmonary tuberculosis in the dialysis patients were 1242/105, persons·year, 932/105, 1.3 year, 155/105 and 17% in maleand 1072/105, 804/105, 1.3 year, 0/105 and 0% in female, respectively. The prevalence, incidence, mortality and fatality were 1.9, 6.4, 9.7 and 1.5 times higher in male dialysis patients than those in thegeneral population, respectively. The prevalence and incidence were 3.5 and 12.4 times higher infemale dialysis patients than those in the general population. The mean duration of the disease wasshorter in dialysis patients: 28% in both sexes of those in the general population.
Pulmonary tuberculosis occupied 67% in male and 44% in female of all tuberculosis amongdialysis patients on June 30, 1976, whereas it was 96% in male and 90% in female among the generalpopulation. Pulmonary tuberculosis occupied 63% in male and 35% in female of all tuberculosisdeveloped during 1976 among the dialysis patients in contrast to 93% in male and 82% in femaleamong the general population. Pulmonary tuberculosis occupied 50% in male and 0% in femaleof all deaths from tuberculosis among dialysis patients, which were much lower than 97% in maleand 91 % in female among the general population.
Prevalence, incidence, mean duration of the disease, mortality and fatality of tuberculosis withsolely pulmonary lesions were 932/105, 854/105, 1.1 year, 155/105 and 18% in male and 402/105, 670/105, 0.6 year, 0/105 and 0% in female, respectively among dialysis patients.
Tuberculosis with solely pulmonary lesions occupied 50% in male and 17% in female of all tuberculosis among dialysis patients on June 30, 1976. This type of tuberculosis occupied 58% in maleand 29% in female of all tuberculosis developed during 1976 among the dialysis patients. This typeof tuberculosis occupied 50% in male and 0% in female of all deaths from tuberculosis among dialysis patients.
Thus, for the first time, a very high vulnerability of pulmonary tuberculosis and the shorter courseof the disease among dialysis patients were proved epidemiologically. Furthermore, the present studydemonstrated a relatively low frequency of pulmonary tuberculosis among all tuberculosis amongdialysis patients in comparison with that among the general population.
