臺灣博碩士論文加值系統

目的：為研究結核病人一般及臨床特徵，治療的順從性，以及診斷方式與死亡的相關性。
方法：對台灣某區域醫院回顧性世代研究。
對象及方法：本研究之對象為1998年1月1日至2001年12月31日該家區域醫院通報至台灣疾病管制局的結核病例，加上病人檢體耐酸性染色陽性及／或結核菌培養陽性的病例、或病理切片有乾酪性變化之病例為本研究之對象。收集這些病人的資料包括一般特徵、人口統計學資料、治療過程、疾病部位、治療用藥、細菌學報告、胸部x光報告分類、治療結果以及每位病人追蹤一年的結果。
結果：該研究期間合計有477名病例符合本研究的對象，其中一半的病人大於60歲，66%為男性。單獨肺結核感染佔65.2%、肺外結核佔31.0%，合併肺及肺外結核有3.8%。71%的病人胸部X光片顯示中度及嚴重性變化，有空洞佔13.2%，肋膜積水有15.7%，輕度變化者佔10.7%， X光片沒有變化者佔4.6%。新病人佔87.6%，58.9%同時患有其他疾病。男性、有糖尿病、塵肺症或慢性肺阻塞疾病及以及中風者易患結核症，但HIV陽性祇有1人。痰液耐酸性染色陽性率為40.1%，痰液培養陽性率為62.6%。追蹤一年治療完成率為74%。病人服用抗結核藥發生藥物不良反應者有25.6%。本研究共有106人死亡(22%)，其中接受完整結核藥物治療後死亡率7.8%，中斷治療者死亡率49.2%，完全未接受治療者死亡率82.1%。因結核病而死亡有73人(15%)。
結論：
　因結核病而死亡的風險比，最重要的因素為藥物治療的順從性不良。年老男性、患有疾病、沒有症狀者、以及服抗結核病藥物沒有不良反應者易造成藥物順從性差。對於易罹結核病的高危險族群應更努力於其藥物順從性的監測。

Objectives To identify the relationships of clinical characteristics, compliance to treatment, and type of diagnosis with the mortality in patients with tuberculosis (TB).
Method A retrospective cohort study was conducted at a regional hospital with 500 beds in northernTaiwan.
Subjects and methods All patients with tuberculosis notified to Center for Disease Control in Taiwan from 1 January 1998 to 31 December 2001 in this hospital were included in this study. Information was collected from their medical records at the commencement of treatment and at 12 months after treatment. The data collected for each patient included demographic characteristics, history of treatment, site of disease, case category, treatment regimen, bacteriological status, radiological category, and treatment outcome results.
Results There were 477 patients meet the inclusion criteria for analysis. Half of the patients were aged 60 years or older, and 66% were male. Pulmonary disease alone accounted for 65.2% of the patients, extrapulmonary lesions only was seen in 31.0%, while both pulmonary and extrapulmonary disease consisted of 3.8%. Newly diagnosed cases comprised 87.6% of the patients, and 58.9% had other concomitant illnesses. There were excess risk of disease among patients who were male, who had diabetes mellitus, pneumoconiosis or chronic obstructive pulmonary disease, and cerebral vascular attack. Only 0.2% of the patients were co-infected with human immunodeficiency virus infection. Among 477 patients evaluated, moderate or severe radiological findings were found in 71.2% of the patients, cavitation in 13.2%, pleural effusion in 15.7%, military lesion in 6.3%, mild infiltration in 10.7%, and no abnormal finding in 4.6%. Sputum acid-fast positive rate was 40.3% and TB culture positive rate was 62.8%. The overall completion rate of treatment at 12 months was 74%. Patient with adverse reaction to antitubewrculosis treatment was 25.6%. Of 477 patients, 106 (22%) died. 7.8% of patients with antituberculosis complete treatment, 49.2% of patients with defaulted treatment, and 82.1% of patients with no treatment died. 15% of all patients died from tuberculosis.
Conclusions Male, patients with co-morbidity, no clinical symptoms or antituberculosis adverse reaction were key factors influencing treatment compliance. Cumulative survival analysis revealed that the predominant factor of TB-related mortality hazard ratio was poor compliance with treatment. Active screening of clearly identified risk groups may be appropriate and requires more efforts to monitor defaulted and untreated patients.

中文摘要 I-II
Abstract III-V
Chapter 1 Introduction 1-2
Chapter 2 Literature Review
1. Pathogenesis and diagnosis 3-5
2. Epidemiology 5-7
3. Cause of failure to TB control 7-8
Chapter 3 Method
1. Study Framework 9
2. Patients 9-11
3. Data Collection 11-12
4. Statistical Analysis 12-13
Chapter 4 Results
1. Descriptive Finding 14-15
2. Compliance to treatment 15-17
3. Acid Fast Stain and TB culture 17
4. Survival 17-19
Chapter 5 Discussion
1. Laboratory diagnosis 20-21
2. Compliance to TB treatment 21-23
3. Prognosis factors 23-24
Tables 25-35
Figures 36-41
Protocol 42-45
Reference 46-51

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