• Title/Summary/Keyword: 당뇨병 유병률

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Treatment Pattern of Patients with Neuropathic Pain in Korea (한국인 신경병성 동통 환자의 치료 양태 연구)

  • Han, Sung-Hee;Lee, Ki-Ho;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.34 no.2
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    • pp.197-205
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    • 2009
  • The purpose of this study was to investigate the treatment pattern of patients with neuropathic pain (NeP) in Korea through computerized database of Health Insurance Review and Assessment Service (HIRAS) over three years' period from 2003 to 2005. The results showed that the numbers of treatment visits were the highest for diabetic neuropathy (DN), followed by postherpetic neuralgia (PHN) and trigeminal neuralgia (TN) in order. Top 3 specialties for treatment visits due to NeP conditions were neurology, neurosurgery and anesthesiology. While cost of a treatment visit was higher in anesthesiology and emergency clinics compared to other clinics, there was a tendency to increase costs for visits to clinics of rehabilitation medicine and family medicine over the three years. Cost of dental visits was relatively high for TN, atypical facial pain (AFP) and atypical odontalgia (AO). Surgeries frequently applied to patients with NeP were sympathetic plexus or ganglion block, block of peripheral branch of spinal nerve and cranial nerve or its peripheral branch block. Most common prescribed medication were anticonvulsants, anti-inflammatory analgesics and anti-psychotic drugs while anti-inflammatory analgesics were overwhelmingly frequently prescribed for AO and glossodynia. Based on the results of this study, NeP disorders more relevant to dentists were AO, TN and AFP, TN of which seems to be the most important in terms of patients' number and cost for treatment visits. This indicates that dentists, especially oral medicine specialists should actively participate in management of TN, AO and AFP and share relevant information with patients and community.

Clinical Characteristics of Elderly Patients with Pulmonary Tuberculosis (고령자 폐결핵에 대한 임상적 관찰)

  • Kim, Chung-Tae;Um, Hye-Suck;Lee, Hyang-Ju;Rhu, Nam-Soo;Cho, Dong-Il
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.4
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    • pp.432-440
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    • 2000
  • Background : The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. Method : We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. Results : The results were as follows : - 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%), dyspnea (40.2%), sputum (38.0%), chest pain (12.0%), anorexia (10.9%), and fever (9.8%). 3) 38 (41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were : -COPD, 25 cases (27.2%); pneumonia, 17 cases (18.5%); DM. 13 cases (14.1%); and malignancy, 10 cases (10.9%). 5) The positivity of Mantoux test (5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB (M. Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases; RLLF, 50 cases, mostly, then LLLF ; 26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows : cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. Conclusion : The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.

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Comparison of the health behavior and nutrition status of young-old women according to the vitality in their quality of life: based on the 2019, 2021 Korea National Health and Nutrition Examination Survey (전기노인 여성의 삶의 질 중 기운에 따른 건강행태와 영양상태 비교: 2019년, 2021년 국민건강영양조사 자료를 이용하여)

  • Jiyoung Jeong;Yoon Jung Yang
    • Journal of Nutrition and Health
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    • v.56 no.5
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    • pp.496-509
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    • 2023
  • Purpose: This study aimed to identify the general characteristics, chronic diseases, health behavior, mental health, and nutritional status of young-old women based on their vitality. Methods: This study used data from the 2019 and 2021 Korea National Health and Nutrition Examination Survey (KNHANES). The subjects were 1,113 young-old women aged 65 to 74 years old. The health-related quality of life concept with an 8-item questionnaire was used to measure the quality of life. Subjects were categorized into 4 groups (always, often, sometimes, never) based on their vitality. General characteristics, chronic diseases, health behavior, dietary behavior, food intake, and nutrient intake were compared among the groups. Results: Age, education level, household income, employment, fruit intake, dietary supplements, abundance of food, and nutrition labeling recognition were associated with the vitality of the subjects. Young-old women with arthritis, diabetes, and osteoporosis displayed lower vitality. Moreover, subjective health status, exercise, activity restrictions, and average daily sitting hours were related to vitality, while no significant difference was found in vitality between smoking and drinking. In terms of mental health factors, higher vitality was associated with 6-8 hours of sleep, lower stress levels, and reduced depression. The high-vitality group exhibited a higher intake of potatoes, starch, mushrooms, fruits, meat, milk, animal oils, and beverages than the low-vitality group. Additionally, the group with higher levels of vitality showed a higher intake of protein, fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, n-6 fatty acids, dietary fiber, sugars, phosphorous, potassium, magnesium, iron, zinc, and riboflavin. Conclusion: This study suggests that the vitality of young-old women is related to socioeconomic factors, health behavior, mental health, and food intake. To maintain a vibrant lifestyle in elderly women, it is necessary to have social and economic stability, prevent arthritis, diabetes, and osteoporosis, exercise regularly, get sufficient sleep, maintain mental health, and have a balanced diet.

Clinical Evaluation of Surgical Resection of Pulmonary Tuberculosis (폐결핵에 대한 외과적 치험)

  • Park, Seung-Kyu;Shon, Mal-Hyun;Han, Dong-Gi;Ha, Hyun-Chul;Jin, Young-Ho;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.474-480
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    • 1995
  • Background: In spite of initial intensive and long-term chemotherapy for pulmonary tuberculosis, many problems remain in the treatment of the residual lesion. The role of surgical intervention for pulmonary tuberculosis is getting rid of such residual lesion of pulmonary tuberculosis to support the healing process and to induce bacteriologically negative conversion in the end. Method: We experienced 30 cases of pulmonary resection for pulmonary tuberculosis from Aug. 1994 through Apr. 1995 in National Masan Tuberculosis Hospital. We conducted retrospective study to analyze several variables for the cases. Results: 1) The ratio between male and female was 4:1(male 24, female 6) and the age of peak incidence was in 3rd and 4th decades. 2) Indications for pulmonary resection in the radiographic findings were cavitary lesions of 19 cases(63.3%), destroyed one side of 8 cases(26.7%) and destroyed one lobe of 3 cases(10%). 3) 16 of 20 cases with unilateral lesions and all of 10 cases with bilateral lesions on chest X-ray films showed AFB positive on preoperative sputum smears. 14 cases(87.5%) of unilateral lesions and 9 cases(90%) of bilateral ones were converted into AFB negative postoperatively. Negative conversion rates of pneumonectomy and lobectomy cases were 100% and 85.7%, respectively. 4) Preoperative combined disease was 3 cases(10%) of DM and postoperative complications were 2 cases(6.7%) of dead space and no death. Conclusion: Chemotherapy only has some limitation in treatment of all tuberculosis. So, surgical intervention for pulmonary tuberculosis is an effective method as partner of chemotherapy.

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Serum leptin, adiponectin and resistin levels in obese children and their correlations with insulin resistance (비만 아동에서 leptin, adiponectin 및 resistin의 혈중농도와 인슐린 저항성과의 관계)

  • Park, Min Young;Ahn, Sun A;Cho, Won Kyoung;Cho, Kyoung Soon;Park, So Hyun;Hahn, Seung Hoon;Jung, Min Ho;Suh, Byung Kyu
    • Clinical and Experimental Pediatrics
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    • v.52 no.7
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    • pp.766-771
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    • 2009
  • Purpose : The objective of this study was to compare the levels of adipocytokines in obesity group with those in control group and examine their correlation with insulin resistance. Methods : We enrolled 36 obese children (male:female [M:F]=17:19; age, $9.3{\pm}1.9yrs$) with ${\geq}95^{th}$ percentile body mass indexes (BMIs) (obesity group) and 35 healthy children (M:F=16:19; age, $9.1{\pm}2.1yrs$) with $25^{th}-75^{th}$ percentile BMIs (control group). We measured the serum leptin, adiponectin, and resistin levels and insulin resistance in both the groups. Results : The weights, heights, BMIs, fasting sugar levels, insulin levels, and homeostasis model assessment for insulin resistance (HOMA-IR) values were higher in the obesity group than in the control group. As compared to the control group, the obesity group showed significantly higher leptin levels and lower adiponectin levels; no significant difference was observed in the resistin levels. The leptin/adiponectin (L/A) ratio was higher in the obesity group than in the control group. In the obesity group, HOMA-IR showed significant positive correlations with weight, height, BMI, and leptin level. However, it was not correlated with age and adiponectin and resistin levels. In the obesity group, leptin level showed significant positive correlations with age, weight, height, and BMI, while adiponectin and resistin levels showed no such correlations with the other variables. Conclusion : We suggest that adiponectin plays an important protective role against weight gain in obese children. Further, L/A ratio can be used as a parameter for predicting the prognosis of obese children.

Associations of Metabolic Syndrome with Glaucoma in Korean - Based on the Korean National Health and Nutrition Examination Survey 2005, 2007-9, 2010 (한국인의 대사증후군과 녹내장 간의 상관관계 -2005, 2007-9, 2010국민건강영양조사 이용)

  • Park, Sang Shin;Kim, Taehun;Pak, Yun-Suk;Lee, Sang-Yoon;Lee, Hae Jung;Lee, Eun-Hee
    • Journal of Korean Ophthalmic Optics Society
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    • v.17 no.2
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    • pp.241-247
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    • 2012
  • Purpose: This study was conducted to assess the association of metabolic syndrome and its components with glaucoma. Methods: We investigated the associations of metabolic syndrome and its components (abdominal obesity, impaired fasting glucose, high blood pressure, and dyslipidemia) with glaucoma using data from 19,162 adults aged 40 or above among the Korean National Health and Nutrition Examination Survey III (2005), IV (2007-9), V (2010). The logistic regression analysis was used for assessing those associations after adjusting demographic, lifestyle, and social economic status and for assessing the association of metabolic medication intakes with glaucoma risks. Results: After adjusting for age and sex, the risk of glaucoma was significantly higher in the subjects with impaired fasting glucose(Odds Ratio (95% confidence interval): 1.78 (1.25, 2.53)) and metabolic syndrome (1.45 (1.01, 2.08)) than subjects without those. These associations increased when additional adjusting for smoking, alcohol use, regular physical activity, income, education status(impaired fasting glucose: 1.89 (1.29, 2.77), metabolic syndrome: 1.52 (1.03, 2.25)). Glaucoma prevalence was borderline significantly increased according to the number of metabolic abnormalities(age and sex adjusted p for trend = 0.055). Use of antihypertensive medication was significantly associated with the risk of glaucoma. Conclusions: Metabolic syndrome and impaired fasting glucose were significantly associated with the increased glaucoma risk. Use of antihypertensive medication was also significantly associated with the increased glaucoma risk.

우리나라의 모자보건사업 (여성과 어린이 건강문제와 증진방안)

  • Park Jeong-Han
    • 대한예방의학회:학술대회논문집
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    • 2002.07b
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    • pp.3-17
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    • 2002
  • 국민건강은 국가발전의 기본조건이다. 국민건강은 건강한 어린이의 출산에서 비롯되고, 건강한 어린이의 출산을 위하여 여성이 건강해야 한다 따라서 여성과 어린이 건강보호와 증진을 위한 모자보건사업은 국가보건사업 중 최우선 사업으로 추진되어야 한다. 우리나라의 모자보건사업은 1960대부터 보건소를 통하여 가족계획, 산전관리, 안전분만유도, 예방접종을 중심으로 하였다. 1980년대에 들어와 전국민의료보험의 실현과 국민생활수준의 향상 등으로 산전관리 수진율과 시설분만율이 급격히 증가하여 1990년대 후반에는 거의 100%에 도달하였고, 가족계획실천율도 1991년에 79.4%까지 증가하여 합계출산율이 1.6으로 감소하였고, 어린이 기본예방접종률도 90%이상이 되어 전염병 발생률이 현저히 감소하였다. 전통적인 모자보건사업 관련 지표들이 이렇게 향상되자 일선 보건요원에서부터 중앙정부의 정책결정권자에 이러기까지 모자보건사업에 대한 관심도가 떨어져 중앙부처의 모자보건업무 담당 부서도 축소되고, 모자보건 사업도 쇠퇴하였다. 그러나 어린이와 여성의 건강실태를 자세히 들여다보면 심각한 문제들이 대두되고 있다. 시설 분만율의 증가에 따라 제왕절개분만율이 40%대까지 급증하였고, 모유수유률은 10%대로 떨어졌다. 어린이의 체격은 커지고 있으나 체력은 떨어지고, 비만한 어린이가 급증하여 당뇨병과 같은 성인병 유병률이 어린이들에게 증가하고, 사고에 의한 어린이 사망과 장애가 늘고 있다. 또한 청소년들의 흡연율과 음주률이 증가하고, 성적 성숙이 빨라지고 사회의 개방풍조로 성(性)활동 연령이 낮아지고 성활동이 증가하여 혼전임신과 성폭력이 증가하고 있다. 여성들은 일찍 단산하고, 폐경 연령은 높아지고, 평균수명은 길어져 중년기와 장년기 그리고 노년기가 길어져 각종 만성질환에 이환될 기회가 늘어났다. 이러한 시기의 중요 건강문제들은 뇌혈관질환, 폐암, 유방암, 골다공증, 뇨실금 등과 같이 해결하기 어려운 것들이다. 이렇게 어린이와 여성들에게 새로운 건강문제들이 대두되고 있으나 이에 대한 대응정책이 없었고, 따라서 새로운 모자보건사업이 개발되지 않았으며 일선 보건요원의 훈련도 없었다. 그리고 이러한 건강실태를 파악하여 대책을 마련하고, 보건사업을 평가할 수 있는 보건정보체계가 없는 실정이다. 1990년대 중반에 소수의 학자들이 어린이와 여성건강문제의 심각성을 제기하고, 모자보건사업 활성화의 필요성을 주장하여 보건복지부가 '모자보건선도보건사업'이라는 이름으로 1999년부터 2001년까지 3년간 23개 보건소에서 시범사업을 시행하였다. 이 시범사업에서는 한정된 자원으로 여성과 어린이 보건문제를 효과적으로 해결하기 위해 새로운 보건사업의 개발과 효율적으로 수행하는 방법의 개발에 역점을 두어 많은 성과를 거두었다. 시범사업의 경험을 바탕으로 2002년에는 전국의 45개 보건소로 확대해나가고 있다. 모자보건선도보건사업에서는 임산부가 대상이었던 기존의 모자보건사업과는 달리 신생아, 영유아, 학동기 어린이, 청소년, 그리고 신혼부부에서부터 장년기 여성에 이르기까지 사업대상을 확대하고 생애주기에 따라 지역사회 건강문제해결을 목표로 한 보건사업을 수행하도록 하였다. 사업수행 과정에서 보건소는 지역내 대학과 협력체계를 구축하여 기술적 지원을 받고, 보건요원의 교육 훈련을 통해 사업기획 능력과 전문지식과 기술을 향상시켰고, 보건교육에 필요한 시설과 장비를 구입하였고, 민간의료기관과 연계하여 보건서비스의 질을 향상시켰다. 모자보건 선도보건소에서 제공하는 서비스는 취약계층 중심의 보건교육, 상담 및 지도, 고위험대상자 조기발견 및 민간기관 의뢰 및 주구관리, 질병 조기발견을 위한 검진 의뢰, 지역 보건통계 생산과 관리, 그리고 지역내 가용자원 안내 등이며, 저소득층에 대해서는 민간의료기관에 의뢰 또는 검진비용을 지원하였다. 이와 같이 지역사회 민간기관과 협력체계를 구축함에 따라 대상자를 지속적으로 관리할 수 있는 정보를 공유하게 되었고, 건강증진 및 질병예방, 치료, 사후관리를 포함한 지속적이고 포괄적인 서비스를 제공할 수 있게 되었다. 특히 고위험 및 건강의심 대상, 임부와 장년기 여성에 대해서는 건강검진서비스를 과감히 민간기관에 의뢰, 위탁하친 보건소는 상담자, 정보관리자로서의 역할로 전환할 수 있었다. 그러나 사업관리자의 양적 평가에 대한 고정관념과 질적 평가에 대한 인식부족, 기본 생정통계와 정보체계의 미비로 인한 부정확한 통계생산, 사업요원의 전문지식과 기술 부족, 그리고 인력부족 등이 문제점으로 대두되었다. 효율적인 사업확산과 조기 정착을 위해 중앙정부의 일관성 있는 정책과 재정적 지원이 필수적이며, 보건정보체계확립, 그리고 공공보건기관과 민간의료기관간의 공식적인 협력체계확립이 필요하다. 사업추진 모니터링 및 평가, 조정을 위하여 중앙에 '모자보건 선도사업 기술지원단'을 구성하여 운영하고, 프로그램 운영이 잘되는 보건소를 특성화 보건소로 지원 육성하고, 사업요원의 업무 적정화를 위한 보건소 조직과 기존 보건사업체계의 평가와 재편이 필요하다. 보건사업요원의 자질 향상을 위한 지속적인 교육 훈련 시스템과 보건통계생산 관리를 위한 정보체계의 구축이 요구된다. 모자보건사업관련 보건교육자료를 수집하고 개발하여 전국 보건소에 공급하는 중앙 보건교육자료 및 정보센터가 필요하다.

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Tranexamic Acid Reduces Postoperative Blood Loss in Reverse Total Shoulder Arthroplasty (역행성 견관절 전치환술에서 트라넥삼산의 출혈 및 수혈 감소 효과)

  • Park, Kee Young;Kim, In Bo;Kim, Eun Yeol;Lee, Kwang Suk
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.5
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    • pp.391-397
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    • 2021
  • Purpose: Tranexamic acid (TXA) can reduce perioperative blood loss and the frequency of blood transfusions in lower extremity surgery. On the other hand, the effects of TXA on reverse total shoulder arthroplasty (rTSA) remain undetermined. This study evaluated the efficacy of TXA on perioperative blood loss, transfusion requirements, and the change in the hemotologic index. Materials and Methods: This study evaluated patients who underwent rTSA from September 2009 to July 2020. The patients were classified into two groups. The TXA group were administered TXA intravenously and topical TXA during surgery. The non-TXA group was not administered TXA. The quantity of hemovac drainage, which represented the postoperative blood loss, transfusion requirements, and postoperative change in hemoglobin and hematocrit level, were recorded. Results: The TXA and non-TXA groups consisted of 93 and 84 patients, respectively. The preoperative demographics showed no significant differences in age (72.0±7.0 vs. 71.5±5.8, p=0.656), sex (male:female, 28:65 vs. 23:61, p=0.689) and the prevalence of hypertension and diabetes (hypertension:diabetes:both, 36:3:13 vs. 32:3:8, p=0.806) between the two groups. There were significant differences in the requirements of transfusion (0 vs. 9, p=0.001), hemovac drainage at the 1st (98.8±61.2 ml vs. 162.7±98.8 ml, p<0.001), the 2nd postoperative day (73.8±48.4 ml vs. 91.5±54.5 ml, p=0.024), hemoglobin level at the 1st (11.7±1.2 g/dl vs. 11.2±1.4 g/dl, p=0.048), 3rd (10.9±1.2 g/dl vs. 10.2±1.2 g/dl, p<0.001), and 6th (11.2±1.3 g/dl vs. 10.7±1.3 g/dl, p=0.020) postoperative day, and the hematocrit level at the 1st (35.0%±3.6% vs. 32.5%±3.8%, p=0.001), 3rd (32.3%±5.0% vs. 29.8%±3.6%, p<0.001), and 6th (33.5%±3.8% vs. 31.5%±3.7%, p<0.001) postoperative day between the two groups. Conclusion: Intravenous and topical intra-articular TXA can reduce the transfusion requirement and blood loss in rTSA.

A Studs on Farmers Syndrome and Its Risk Factors of Vinylhouse Workers and Evaluation of Risk Factors of Vinylhouse Works (일부 농촌지역 비닐하우스 농사자들의 작업환경 및 농부증 실태와 관련요인평가)

  • Lee, Jung-Jeung
    • Journal of agricultural medicine and community health
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    • v.29 no.1
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    • pp.101-119
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    • 2004
  • Objectives: In order to estimate risk factors affecting the health of vinylhouse workers and harmful environments in vinylhouse working. Methods: The investigator performed questionnaires and laboratory examinations on 102 vinylhouse workers and 69 farmers in 7 myoens (Korean subcounties). one eup (a Korean town), Goryeong-gun, Gyeongsangbuk-do between April 8 and 18, 2004 (for 11 days), and measured the heavy metal in the air and the soil, temperature, humidity, air current, harmful gases in vinylhouses. Results: Even in cloudy days, the temperature in vinylhouses in daylight was $33.4^{\circ}$ and the temperature difference between inside and outside vinylhouses was around $16^{\circ}$. Oxygen concentration was similar inside and outside vinylhouses, while carbon dioxide concentration was lower inside than outside vinylhouses. Carbon monoxide was not detected. In the air inside vinylhouses, cadmium was not detected. Lean concentration in the soil was lower inside vinylhouses than outside vinylhouses at surface, while cadmium concentration was similar inside and outside vinylhouses in the soil except some areas. Out of male vinylhouse workers. 16.4---- were positive farmer's syndrome and 49.2---- were suspicious, while out of females, 41.5---- were positive and 46.3---- were suspicious. Out of male farmers, 30.4---- were positive farmer's syndrome, while out of female farmers, 60.0---- were positive and 28.3---- were suspicious. There was no difference between vinylhouse workers and farmers in the distribution of hypertension and abnormal liver function, while diabetes mellitus was more common in farmers than in vinylhouse workers. Vinylhouse working, sex, and hours of farming per day were selected as significant variables affecting farmer's syndrome in this study, and the rate of positive farmer's syndrome was rather lower in vinylhouse workers than in farmers. Females were higher than males in the rate, and those who farmed at least 10 hours per day were higher in the rate than those who farmed less than 10 hours per day. Out of the vinylhouse workers, no differences were found between the distribution of farmer's syndrome and farming-related variables such as the total period of farming, the size of farm land, the mean farming hours per day, the number of family members who farm together, the frequency of scattering agricultural chemicals. In addition, there were no differences between the distribution and the wearing masks and protectors and personal sanitation among those who scattered agricultural chemicals by themselves. There were no differences found in blood lean concentration, urinary cadmium concentration, serum cholinesterase, and hemoglobin according to the distribution of farmer's syndrome. In the vinylhouse workers, females were higher than males in the rate of farmer's syndrome, and those who farmed at least 10 hours per day were higher in the rate than those who farmed less than 10 hours per day. Meanwhile, the rate was lower in those who slept at least 8 hours a day than in those who slept less than 8 hours. Conclusions: In conclusion, the physical environments inside vinylhouses were harmful, but no significant difference was found in harmfulness of the chemical environments. The chronic diseases such as farmer's syndrome. hypertension, diabetes, and dyshepatia were not common in the vinylhouse workers than in the farmers. Meanwhile, farmer's syndrome was more common in the vinylhouse workers who worked longer and slept less.

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National Survey of Mycobacterial Diseases Other Than Tuberculosis in Korea (비결핵항산균증 전국 실태조사)

  • 대한결핵 및 호흡기학회 학술위원회
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.3
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    • pp.277-294
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    • 1995
  • Background: The prevalence of tuberculosis in Korea decreased remarkably for the past 30 years, while the incidence of disease caused by mycobacteria other than tuberculosis is unknown. Korean Academy of Tuberculosis and Respiratory Diseases performed national survey to estimate the incidence of mycobacterial diseases other than tuberculosis in Korea. We analyzed the clinical data of confirmed cases for the practice of primary care physicians and pulmonary specialists. Methods: The period of study was from January 1981 to October 1994. We collected the data retrospectively by correspondence with physicians in the hospitals that referred the specimens to Korean Institute of Tuberculosis, The Korean National Tuberculosis Association for the detection of mycobacteria other than tuberculosis. In confirmed cases, we obtained the records for clinical, laboratory and radiological findings in detail using protocols. Results: 1) Mycobacterial diseases other than tuberculosis were confirmed that 1 case was in 1981, 2 cases in 1982, 4 cases in 1983, 2 cases in 1984, 5 cases in 1985, 1 case in 1986, 3 cases in 1987, 1 case in 1988, 6 cases in 1989, 9 cases in 1990, 14 cases in 1990, 10 cases in 1992, 4 cases in 1993, and 96 cases in 1994. Cases since 1990 were 133 cases(84.2%) of a total. 2) Fifty seven percent of patients were in the age group of over 60 years. The ratio of male to female patients was 2.6:1. 3) The distribution of hospitals in Korea showed that 61 cases(38.6%) were referred from Double Cross Clinic, 42 cases(26.6%) from health centers, 21 cases(13.3%) from tertiary referral hospitals, 15 cases(9.5%) from secondary referral hospitals, and 10 cases(6.3%) from primary care hospitals. The area distribution in Korea revealed that 98 cases(62%) were in Seoul, 17 cases(10.8%) in Gyeongsangbuk-do, 12 cases(7.6%) in Kyongki-do, 8 cases(5.1%) in Chungchongnam-do, each 5 cases(3.2%) in Gyeongsangnam-do and Chungchongbuk-do, 6 cases(3.8%) in other areas. 4) In the species of isolated mycobacteria other than tuberculosis, M. avium-intracellulare was found in 104 cases(65.2%), M. fortuitum in 20 cases(12.7%), M. chelonae in 15 cases(9.5%), M. gordonae in 7 cases(4.4%), M. terrae in 5 cases(3.2%), M. scrofulaceum in 3 cases(1.9%), M. kansasii and M. szulgai in each 2 cases(1.3%), and M. avium-intracellulare coexisting with M. terrae in 1 case(0.6%). 5) In pre-existing pulmonary diseases, pulmonary tuberculosis was 113 cases(71.5%), bronchiectasis 6 cases(3.8%), chronic bronchitis 10 cases(6.3%), and pulmonary fibrosis 6 cases(3.8%). The timing of diagnosis as having pulmonary tuberculosis was within 1 year in 7 cases(6.2%), 2~5 years ago in 32 cases(28.3%), 6~10 years ago in 29 cases(25.7%), 11~15 years ago in 16 cases(14.2%), 16~20 years ago in 15 cases (13.3%), and 20 years ago in 14 cases(12.4%). Duration of anti-tuberculous treatment was within 3 months in 6 cases(5.3%), 4~6 months in 17 cases(15%), 7~9 months in 16 cases(14.2%), 10~12 months in 11 cases(9.7%), 1~2 years in 21 cases(18.6%), and over 2 years in 8 cases(7.1%). The results of treatment were cure in 44 cases(27.9%) and failure in 25 cases(15.8%). 6) Associated extra-pulmonary diseases were chronic liver disease coexisting with chronic renal failure in 1 case(0.6%), diabetes mellitus in 9 cases(5.7%), cardiovascular diseases in 2 cases(1.3%), long-term therapy with steroid in 2 cases(1.3%) and chronic liver disease, chronic renal failure, colitis and pneumoconiosis in each 1 case(0.6%). 7) The clinical presentations of mycobacterial diseases other than tuberculosis were 86 cases (54.4%) of chronic pulmonary infections, 1 case(0.6%) of cervical or other site lymphadenitis, 3 cases(1.9%) of endobronchial tuberculosis, and 1 case(0.6%) of intestinal tuberculosis. 8) The symptoms of patients were cough(62%), sputum(61.4%), dyspnea(30.4%), hemoptysis or blood-tinged sputum(20.9%), weight loss(13.3%), fever(6.3%), and others(4.4%). 9) Smear negative with culture negative cases were 24 cases(15.2%) in first examination, 27 cases(17.1%) in second one, 22 cases(13.9%) in third one, and 17 cases(10.8%) in fourth one. Smear negative with culture positive cases were 59 cases(37.3%) in first examination, 36 cases (22.8%) in second one, 24 cases(15.2%) in third one, and 23 cases(14.6%) in fourth one. Smear positive with culture negative cases were 1 case(0.6%) in first examination, 4 cases(2.5%) in second one, 1 case (0.6%) in third one, and 2 cases(1.3%) in fourth one. Smear positive with culture positive cases were 48 cases(30.4%) in first examination, 34 cases(21.5%) in second one, 34 cases(21.5%) in third one, and 22 cases(13.9%) in fourth one. 10) The specimens isolated mycobacteria other than tuberculosis were sputum in 143 cases (90.5%), sputum and bronchial washing in 4 cases(2.5%), bronchial washing in 1 case(0.6%). 11) Drug resistance against all species of mycobacteria other than tuberculosis were that INH was 62%, EMB 55.7%, RMP 52.5%, PZA 34.8%, OFX 29.1%, SM 36.7%, KM 27.2%, TUM 24.1%, CS 23.4%, TH 34.2%, and PAS 44.9%. Drug resistance against M. avium-intracellulare were that INH was 62.5%, EMB 59.6%, RMP 51.9%, PZA 29.8%, OFX 33.7%, SM 30.8%, KM 20.2%, TUM 17.3%, CS 14.4%, TH 31.7%, and PAS 38.5%. Drug resistance against M. chelonae were that INH was 66.7%, EMB 66.7%, RMP 66.7%, PZA 40%, OFX 26.7%, SM 66.7%, KM 53.3%, TUM 53.3%, CS 60%, TH 53.3%, and PAS 66.7%. Drug resistance against M. fortuitum were that INH was 65%, EMB 55%, RMP 65%, PZA 50%, OFX 25%, SM 55%, KM 45%, TUM 55%, CS 65%, TH 45%, and PAS 60%. 12) The activities of disease on chest roentgenogram showed that no active disease was 7 cases(4.4%), mild 20 cases(12.7%), moderate 67 cases(42.4%), and severe 47 cases(29.8%). Cavities were found in 43 cases(27.2%) and pleurisy in 18 cases(11.4%). 13) Treatment of mycobacterial diseases other than tuberculosis was done in 129 cases(81.7%). In cases treated with the first line anti-tuberculous drugs, combination chemotherapy including INH and RMP was done in 86 cases(66.7%), INH or RMP in 30 cases(23.3%), and not including INH and RMP in 9 cases(7%). In 65 cases treated with the second line anti-tuberculous drugs, combination chemotherapy including below 2 drugs were in 2 cases(3.1%), 3 drugs in 15 cases(23.1%), 4 drugs in 20 cases(30.8%), 5 drugs in 9 cases(13.8%), and over 6 drugs in 19 cases (29.2%). The results of treatment were improvement in 36 cases(27.9%), no interval changes in 65 cases(50.4%), aggravation in 4 cases(3.1%), and death in 4 cases(3.1%). In improved 36 cases, 34 cases(94.4%) attained negative conversion of mycobacteria other than tuberculosis on cultures. The timing in attaining negative conversion on cultures was within 1 month in 2 cases(1.3%), within 3 months in 11 cases(7%), within 6 months in 14 eases(8.9%), within 1 year in 2 cases(1.3%) and over 1 year in 1 case(0.6%). Conclusion: Clinical, laboratory and radiological findings of mycobacterial diseases other than tuberculosis were summarized. This collected datas will assist in the more detection of mycobacterial diseases other than tuberculosis in Korea in near future.

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