当院における悪性腫瘍を合併した結核症例の検討

Abstract

当院は結核病床を有する市中総合病院であるため，結核症例の高齢化とともに増加してきている悪性腫瘍などの合併症をもっ た結核症例を受け入れることが多い．2007 年4 月から2012 年6 月の間に当院で入院治療を行った結核症例223 例のうち，悪性 腫瘍を有した24 例について後ろ向きに検討を行った．合併した癌種は肺癌6 例，胃癌4 例，前立腺癌4 例，肝細胞癌2 例，そ の他8 例．結核治療終了時において生存13 例，死亡11 例だった．死亡例は生存例に比し年齢では有意な差はなく，入院時の 血清Alb 値は低く，performance status（ PS ）は悪かった．悪性腫瘍合併結核症例は予後不良であったが，悪性腫瘍を合併し ていても抗結核薬投与を行っていくことは可能で，栄養状態，PS が比較良好であれば，排菌停止後，悪性腫瘍治療を十分行う ことができた．年齢よりも栄養状態やPS が管理において重要な指標になる可能性があり，癌治療医と結核治療医の緊密な連携 が必要である．

Our hospital is a community hospital with beds for tuberculosis. Therefore many tuberculosis cases with complications such as malignant tumors are increasing with the aging of tuberculosis patients. Of 223 cases of tuberculosis seen at our hospital from April 2007 to June 2012, 24 cases with malignant tumors were retrospectively analyzed. The cancer types involved were 6 cases of lung cancer, 4 cases of gastric cancer, 4 cases of prostate cancer, 2 cases of hepatocellular carcinoma and 8 other cases. At the end of tuberculosis treatment, 13 patients survived and 11 died. There was no significant difference in age at death compared to the survivals, but the serum Alb levels at admission were lower and performance status (PS) was poorer. Tuberculosis cases with malignant tumors had a poor prognosis, but it was possible to administer anti-tuberculosis drugs. If nutritional status and PS are comparatively good, and the malignant tumor was successfully treated. Nutritional status and PS may be more important indicators in management than age. Close cooperation between oncologists and specialist physicians for tuberculosis is necessary.