TUBERCULOSIS IN YOUNG-ADULTS AND THE ELDERLY - A PROSPECTIVE COMPARISON STUDY
TUBERCULOSIS IN YOUNG-ADULTS AND THE ELDERLY - A PROSPECTIVE COMPARISON STUDY
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DOI：
10.1378/chest.106.1.28
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发表时间：
1994-07-01
期刊：
影响因子：
9.6
通讯作者：
FITZGERALD, JM
中科院分区：
文献类型：
--
作者：
KORZENIEWSKAKOSELA, M;KRYSL, J;FITZGERALD, JM
目的：比较年轻人和老年人肺结核和胸膜结核的临床、细菌学和放射学特征，并确定两组之间是否存在任何差异。设计：前瞻性招募加拿大不列颠哥伦比亚省诊断为肺结核和胸膜结核的所有患者。设置：来自省级结核病登记控制项目的基于人群的样本。患者：1990年1月至1991年5月期间，共有218名连续患者被诊断出病情。我们排除了15名在本研究期间被诊断出病情的艾滋病毒阳性患者。干预：由两名不了解临床和流行病学数据的读者进行症状、细菌学和放射学审查的标准化数据收集。主要结果：有142名年轻成年患者和76名老年患者。年轻成人的平均年龄为41.2岁，老年组的平均年龄为75岁。发热（p=0.002）和盗汗（p=0.02）在年轻人中更常见。在培养证实的疾病中，咯血、发热和咳嗽在年轻成人中更常见（分别为p=0.03、0.02和0.01）。两组之间的症状持续时间没有差异。老年组中除肺癌以外的其他癌症的比值比为3.98（置信区间为1.49，10.65），是两组之间唯一存在差异的显著风险因素。皮肤试验对5TU PPD的反应在86.2%的年轻人和67.6%的老年患者中呈阳性（p=0.03）。共有79.6%的年轻人和88.15%的老年患者（不显著）培养阳性。年轻人与老年人的放射学结果比较显示，除了粟粒性结核患者0.7%与6.7%（p=0.04）外，无显著差异。结论：在这项以人群为基础的研究中，年轻人更容易出现咯血、发热和咳嗽，PPD反应阳性。在老年组中，癌症是一个显著相关的风险因素。除了老年人更常见的粟粒性结核病外，两组之间的细菌学证实的疾病或放射学发现没有差异。
Objectives: To compare the clinical, bacteriologic, and radiologic features of pulmonary and pleural tuberculosis in young adults and the elderly and determine if any differences exist between both groups.Design: Prospective recruitment of all patients diagnosed as having pulmonary and pleural tuberculosis in British Columbia, Canada.Setting: A population-based sample from a provincial control program TB registry.Patients: A total of 218 consecutive patients whose conditions were diagnosed between January 1990 and May 1991. We excluded 15 HIV-positive patients whose conditions were diagnosed during this study.Intervention: Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical and epidemiologic data.Main results: There were 142 young adult patients and 76 elderly patients. The young adults had a mean age of 41.2 years and the elderly group had a mean age of 75 years of age. Fever (p=0.002) and night sweats (p=0.02) were more common in young adults. In culture-proven disease, hemoptysis, fever, and cough were more common in young adult (p=0.03, 0.02, and 0.01, respectively). There was no difference in the duration of symptoms between the two groups. The odds ratio for cancers other than lung cancer, 3.98 (confidence interval 1.49, 10.65) in the elderly group was the only significant risk factor to differ between the two groups. Skin test responses to 5TU PPD were positive in 86.2 percent of young adults and 67.6 percent of elderly patients tested (p=0.03). A total of 79.6 percent of young adults and 88.15 percent of the elderly patients (not significant) were culture positive. Comparison of radiologic findings in young adults vs elderly patients showed no significant differences apart from those with miliary TB 0.7 percent vs 6.7 percent (p=0.04).Conclusions: In this population-based study, young adults were more likely to have hemoptysis, fever, and cough and to have a positive PPD response. Cancer was significantly associated as a risk factor in the older age group. There was no difference in bacteriologically proven disease or radiologic findings between the two groups, apart from the more common occurrence of miliary TB in the elderly.