| Objective:To study the differences between clinical characteristics of elderly patients and younger patients with tuberculosis,in order to improve the understanding and ability of diagnosis and treatment of elderly patients with tuberculosis.Methods:The clinical data of inpatients with pulmonary tuberculosis(pulmonary tuberculosis,tracheobronchial tuberculosis,and tuberculous pleurisy)diagnosed from January 1,2018 to December 31,2018 in the affiliated hospital of Southwest Medical University were retrospectively analyzed.Use Excel to analyze the patient's gender,age,clinical symptoms and signs,course of disease,comorbidities,laboratory examination,chest imaging examination,respiratory endoscopy(electronic bronchoscopy and internal medicine thoracoscopy),pathological characteristics,pathological results,etc.Registered and grouped into elderly group(age?60 years)and younger group(age 18?age<60 years)according to age,and compared the gender and age,clinical manifestations,laboratory tests,pulmonary imaging,and respiratory endoscopy of the two groups.Examination and histopathological differences.SPSS 25.0 statistical software was used for statistical analysis,and the chi-square(?2)test was used to analyze the differences of the above indicators.Results:1.A total of 621 patients with tuberculosis were included in the study.Gender and Age:424 were male,accounting for 68.28%of the total number,197were female,accounting for 31.72%,and the ratio of male to female was 2.15:1.There were 401 cases in the younger patients(aged 18 to 59 years),accounting for 64.57%,251 males and 150 females,with an average age of 51.37±13.41years;There were 220 elderly patients(age?60 years),accounting for 35.43%,173 males and 47 females,with an average age of 68.30±6.30 years.Males which with pulmonary were more common in the two groups,This phenomenon was more common in elderly patients,and the difference was statistically significant(P<0.0001).2.Clinical symptoms and signs:Cough,sputum and dyspnea are more common in the elderly patients than in the younger patients.The difference is statistically significant(P<0.001).The symptoms of night sweats and chest pain were more common in the younger patients,and the difference was statistically significant(P<0.05).There was no significant difference in symptoms of hemoptysis,fever,fatigue,wasting,hot flashes,poor appetite,and chest tightness between the two groups(P>0.05).The proportion of lung signs in the elderly group was higher than that in the younger group(P<0.05).3.Course of disease:The course of disease among the two groups ranged from2~+hours to 40~+years.The percentage of patients in the two groups was the most from 1month to 1 year.The difference was not statistically significant(P>0.05).Patients with a disease course of less than 1 month were more common than the elderly group,and the difference was statistically significant(P<0.05).Patients with a disease course of more than 1 year were more common in the elderly group than the younger group,and the difference was statistically significant(P<0.05).4.Complications:90.00%of patients with comorbidities in the elderly patients were significantly more than 54.36%in the younger patients,the difference was statistically significant(?2=81.581,P<0.001);Patients in the elderly group had two or more comorbidities simultaneously were more than the younger group,and the difference was statistically significant(?2=25.124,P<0.001).5.Laboratory examinations:elderly patients with increased neutrophil ratio(NEU-R),elevated C-reactive protein(CRP),elevated procalcitonin(PCT),decreased hemoglobin(HB),albumin(ALB)reduction were more common than the younger group,the difference is statistically significant(P<0.05),and the changes between elderly and younger patients were no difference in white blood cell count(WBC),neutrophil count(NUE),platelet(PLT)There was no statistically significant difference in the comparison(P>0.05);The positive rate of tuberculin skin test(TST)in the younger patients was higher than that in the elderly patients,and the difference was statistically significant(P<0.05).The positive rate of?-interferon release test,the positive rate of Gene X-pert,and the positive rate of TB-DNA There was no significant difference between the groups(P>0.05);The positive rate of sputum bacteria in elderly patients(47.57%)was higher than that in younger patients(30.41%).The difference was statistically significant(P<0.001).6.Imaging examinations:In the younger group,the completion rate of chest radiography was 99.25%(398/401),and the number of patients with multiple lung areas was 57.03%(227/398),followed by 48 cases(12.06%)involving only the upper right lung.),45 cases of right lower lung(11.31%),13 cases of right middle lung(3.27%),32 cases of upper left lung(8.04%),33 cases of left lower lung(8.29%);chest of elderly patients The perfect rate of imaging examination was 99.55%(219/220),and the lesions were mainly distributed in multiple lung areas,accounting for 75.34%(165/219),followed by16 cases(7.31%)and 6 cases of left lower lung,respectively.(2.74%),16 cases of right upper lung(7.31%),11 cases of right lower lung(5.02%),and 5 cases of right middle lung(2.28%).The imaging findings of chest in the elderly group were more extensive than in the younger group.The lesions were mostly distributed in multiple lung areas,and the difference was statistically significant(P<0.0001).In the comparison of the distribution of lesions in the single lung area between the two groups,the lesions only accumulated in the left lower lung and The right lower lung group was less common in the elderly group than the younger group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of lesions involving only the upper left lung,upper lung,and right middle lung(P>0.05).The morphology of chest imaging lesions in the two groups were mainly spotted,nodular,patchy,cord-like high-density shadow,hollow shadow,pleural effusion,pleural thickening,adhesion,etc.In addition,it can also be manifested as pulmonary consolidation,atelectasis,multiple calcifications,bronchial wall thickening/luminal stenosis,lumps,lung damage,and caseous pneumonia,with no significant difference(P>0.05).7.Endoscopic performance:There were 86patients completed bronchoscopy in the younger group,accounting for 21.45%of the total number;There were 38 patients with complete bronchoscopy in the elderly group,accounting for 17.27%of the total number in this group.The bronchoscopy manifestations were mainly bronchoconstriction,mucosal hypertrophy or erosion,and mucosal surface necrosis or secretion attachment.There was no significant difference in bronchoscopy performance between the two groups of patients(P>0.05).Pathological biopsies were mainly granulomatous inflammation,caseous necrosis,chronic mucosal inflammation,and fibrous tissue hyperplasia,with no significant difference(P>0.05);There were 21 complete thoracoscopy patients in the two groups.The main performances of thoracoscopy were scattered nodules,the formation of a large number of adhesions,pleural thickening,and congestion.There was no significant difference in thoracoscopy performance between the two groups(P>0.05).The results of pathological examination were mainly granulomatous inflammation,caseous necrosis,and fibrous tissue exudation.There was no significant difference(P>0.05).8.Percutaneous lung biopsy:There were 12patients with perfect percutaneous lung biopsy in the two groups,7 in the younger group,of which 6 patients were negative for sputum and 1 patient was asymptomatic.There were 5 cases of puncture lung biopsy,3 cases were smear negative tuberculosis,and 2 cases did not obtain sputum specimens for sputum smear microscopy.Histopathology of lung biopsy of the two groups of patients showed tuberculosis,which was mainly manifested by chronic granulomatous inflammation and caseous necrosis,and the difference was not statistically significant(P>0.05).9.Adverse Drug Reactions:The incidence of adverse drug reactions in the younger group was 32.68%(100/306),liver damage was 11.00%(11/100),gastrointestinal reactions were 11.00%(11/100),and allergic reactions were 7.00%(7/100),joint pain and nervous system damage were each 1.00%(1/100),and uric acid increased by 69.00%(69/100).The incidence of adverse drug reactions in elderly patients was 44.38%(71/160),liver damage was 22.54%(16/71),gastrointestinal reactions were 19.72%(14/71),allergic reactions were5.63%(4/71),joints There was 1 case of pain and neurological damage,each accounting for 1.41%,and 49.29%(35/71)of those with elevated uric acid.The overall incidence of adverse reactions was higher in the elderly group than in the younger group,and the difference was statistically significant(?2=6.186,P=0.013).Moreover,liver function impairment was more common in the elderly group than in the younger group,and the difference was statistically significant(P<0.05).Elevated uric acid was more common in the younger group than in the elderly group,with a significant difference(P<0.05).There was no significant difference in the incidence of adverse reactions such as gastrointestinal reactions,allergic reactions,joint pain,and nervous system damage(P>0.05).Conclusion:1.Elderly patients with pulmonary tuberculosis have the characteristics of atypical clinical symptoms,more complicated underlying diseases,longer course of disease,diverse chest imaging findings,extensive distribution of lesions,and lower tuberculin skin test positive rate.2.There is no significant difference in the performance of bronchoscopy and thoracoscopy and the results of medical examination between elderly group and younger group.3.The adverse reactions of anti-tuberculosis drugs in elderly patients with pulmonary tuberculosis are more likely to occur than in non-elderly patients with tuberculosis.Therefore,treatment should also pay attention to individual treatment,improve the clinical cure rate,and improve the safety of patients'medication. |
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