Clinical Characteristics Of Middle - Aged And Elderly Tuberculosis And Retrospective Analysis Of Distribution Of TCM Syndromes

Objective:To strengthen the prevention and control of pulmonary tuberculosis, defend the public safety, improve medical workers’vigilance and occupational protection, carrying out the clinical research of middle-aged and old tuberculosis patients.Methods:Retrospectively analyze 95 middle-aged and old hospitalized tuberculosis patients aged greater than or equal to 45 years old in Chengdu university of Traditional Chinese Medicine(TCM) from March the 2013 to February of 2015.Collect epidemiological data, clinical symptoms, laboratory and imaging examination, diagnosis and syndrome differentiation of TCM, western medicine diagnosis. Use SPSS 19.0 software for statistical analysis.Results:1.There is 194 pulmonary tuberculosis patients from March the 2013 to February of 2015 in Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. Of which middle-aged and old tuberculosis patients 95 cases. In the 95 middle-aged and old tuberculosis patients, men take over 71 and women 24. Men and women on average ratio is about 2.96:1.The biggest difference stage between men and women concentrated in the 65～84 years old stage, up to 6.67:l;and the smallest difference concentrated in the 55～64 years old age, about 1.38:1. The peak incidence of men happens in 65～84 years old, and women in 55～64 years old.2. Epidemiological characteristics:the career distribution of middle-aged and old hospitalized tuberculosis patients is the majority (41.05%) and farmers (40.00%). Patients mainly live in the country taking over 58.95%. Medical history were mainly follows, surgery 16 cases (16.84%), pulmonary tuberculosis 12 cases (12.63%), diabetes 8 cases (8.42%), fractures 6 cases (6.32%). History of tuberculosis contact were mostly unclear, and the treatment was specification.3.Symptoms characteristic mainly cough (89.47%), cough with phlegm (74.74%), dyspnea(80%), poor appetite(38.95%)., followed by a chest pain (33.68%),hot flashes (33.68%), emaciation (24.21%),night sweat(22.11%), haemoptysis (21.05%) and fatigue (18.95%).The characteristics mainly composed several symptoms at the same time, including cough, phlegm and dyspnea. There is no statistical significance (P> 0.05)between men and women in the symptoms.4.The acid fast bacilli positive takes 37 cases (38.95%), including direct sputum smear-positive 25 cases (26.32%), and 19 cases (20.00%)diagnosed by fiber bronchoscope examination, in which 12 cases sputum smear negative.42 cases negative tuberculosis and 16 cases tuberculous pleurisy (including 1 case of sputum smear-positive)4.Chest CT scan on senile pulmonary tuberculosis patients with double lung lesions 22.86%,left upper lobe 19.05%,left lung lower lobe 15.24%, the right upper lobe 17.14%, the middle of right lung 7.62%, and 18.10% of right lung lower lobe. CT scan showed diversity changes, including consolidation, hollow, calcification, diffuse infiltration, fiber show in the movie, nodules and masses, liminated atelectasis and partial tractional bronchiectasis, and lymph node enlargement, pleural thickening and pleural effusion. The nodular shadows (19.38%) and pleural effusion (21.87%).Pleural effusion appears large number of effusion accounted for 7%, and 9% in quantity.6.In the 95 middle-aged and old tuberculosis patients, positive mycobacterium tuberculosis antibody was 21 cases, and 9 positive cases(36%)in 25 sputum smear-positive cases; PPD skin test positive for 28cases (29.47%) and 8 positive cases(32%)in 25 sputum smear-positive cases. The Kappa consistency inspection results between sputum smear and PPD, mycobacterium tuberculosis antibody test does not have consistency, suggesting that we can not diagnoses the tuberculosis only with the two methods. Blood sedimentation was abnormal in 63 (66.32%), abnormal value range 60.80 ± 32.249mm/h. Reflect the protein C was abnormal in 57(60%), abnormal value range 70.34 ± 56.174ng/ml.7.Merging disease:chronic lung diseases such as chronic bronchitis, emphysema and pulmonary heart disease take over 44.21%, followed by community-acquired pneumonia (17.89%), diabetes (17.89%), hypoalbuminemia (15.79%), hyperlipidemia 11.85% and anemia 10.53%.Music bacterium lung disease 3.13%,combination of mammary tuberculosis in 1 case (1.05%), the slave card disease 2 cases (2.11%), cardiac relaxation loss in 1 case (1.05%).8.TCM syndrome types:Qi and Yin deficiency takes over 26 cases (27.37%), hyperactivity of fire due to yin deficiency 18 cases (18.95%), fluid retained in chest and hypochondrium 16 cases(16.84%) and phlegm heat syndrome 15cases (15.79%), phlegm and blood stasis syndrome 10 cases(10.53%), deficiency of both yin and yang 4cases(4.21%), lung and spleen qi deficiency 3 cases(3.16%),and lung and kidney yin deficiency 3 cases(3.16%).Conclusion:1.The middle-aged and old tuberculosis patients take an important role in pulmonary tuberculosis patients, but the symptoms are not typical. In clinical patients coughing and phlegm more than 2 weeks with abnormal CT scans should be paid attention to tuberculosis, especially suffering with surgeries, diabetes, or long term using of immunosuppressive agents or hormone drugs.2. Since the chest CT scan are not typical, the diagnosis of middle-aged and old tuberculosis patients depends on several examination. Abnormal blood sedimentation and CRP have auxiliary significance for diagnosis. The fiberobronchoscope examination has important significance in tuberculosis diagnosis and differential。3.The merging disease of middle-aged and old tuberculosis patients is complex. Treatment in addition to the anti-tuberculosis drug treatment, combined diseases’ treating is also needed. Both traditional and western methods should be taken to enhance resistance.4.The TCM syndrome types are not mainly with qi and Yin deficiency syndrome and lung Yin deficiency. Phlegm heat resistance lung syndrome, phlegm and blood stasis syndrome and syndrome of fluid retaining in chest are also relatively common.