肺內、肺外結核通報後的流行病學初探──以北部某區域醫院為例

Preliminary Study on Epidemiology of Tuberculosis in a Regional Hospital in North Taiwan

本研究統計資料係取自北部某區域醫院2007～2017年通報結核病登錄確診個案，另搭配「中央傳染病追蹤管理系統」進行病歷資料回溯性研究分析。分析結果顯示研究期間個案醫院，在年齡大於21歲，共通報305位結核病個案，其中194人存活，111位死亡。以Cox比率風險模型分析結核病患者死亡因子與年齡及有無慢性病具有顯著差異。罹患肺外結核（EPTB）平均年齡為51.9歲、肺內結核（PTB）平均59.6歲。整體TB的男女性別比為1.82：1，以PTB而言男女性別比為2.35：1，以EPTB而言男女性別比為0.89：1.0。男性PTB與EPTB於研究期間所呈現的百分比中各年度男性PTB病例數大於EPTB病例數。女性EPTB似乎有上升而凌駕與PTB相近的發生趨勢。主要是女性EPTB的39歲以下族群為非本國籍女性較多的結果。TB病人在EPTB與PTB的死亡風險並無顯著差異。然而在年齡層死亡風險Kaplan-Meier風險函數，以年齡層比較而言：TB病人61歲至80歲族群與40歲族群間，增加0.11倍的死亡風險。病人在81歲以上族群與40歲族群間，增加0.41倍的死亡風險。研究結論對罹患EPTB與PTB的死亡風險並無顯著差異，主要的死亡風險因子是年齡。但39歲以下族群非本國籍女性EPTB似乎有上升而凌駕與PTB的趨勢，此訊息可提供我國未來持續引進外籍勞工（或看護）的結核病防治策略參考。

Data of this study was taken from the registered confirmed cases of tuberculosis reported from a regional hospital during 2007 to 2017 in north Taiwan, and the Taiwan National Infectious Disease Statistics System (https://tb2035.cdc.gov.tw/) is used for retrospective research and analysis of medical records. The results showed that during the study period, the case hospital reported 305 tuberculosis cases and the age more than 20 years old, in which 194 were alive and 111 died. The Cox proportional hazard model was used to analyze the death factors of tuberculosis patients with age and the patient with or without chronic diseases. The mean age of suffering from extrapulmonary tuberculosis (EPTB) was 51.9 years old, and the mean age of pulmonary tuberculosis (PTB) was 59.6 years old. The overall male-to-female ratio of TB is 1.82:1, the male-female ratio is 2.35:1 for PTB, and 0.89:1.0 for EPTB. The male PTB was greater than the EPTB. Female EPTB was on the rising and similar occurrence trend with the PTB. The reason is that the population under 39 years of age with female EPTB has more foreign females. The Kaplan-Meier risk model was shown that the TB patients with the age-ranks were significance associated with the death risk. The TB patients between 61 to 80 years old compared with the below 40 years group, the risk of death were increased 0.11 times. Patients between the more than 81-year-old group compared with the below 40-year-old group were increased the risk of death by 0.41 times. The research conclusions that EPTB of non-native females under the age of 39 seems to have a tendency to rise and override PTB. This information can provide a reference feature for future prevention strategies policy for the foreign employee.