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Journal of the Korean Academy of Family Medicine 2005;26(8):481-489.
Published online August 10, 2005.
Clinical Characteristics, Diagnosis, Treatment, and Clinical Outcomes of TB Patients at a Private University Hospital in Korea.
Seong Hoon Choi, Woo Sung Sun, Mi Na Kim, Tae Sun Shim
1Department of Family Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
2Department of Diagnostic Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
3Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. shimts@amc.seoul.kr
국내 한 민간종합병원에서 결핵 환자의 진단 및 치료 실태
: Even though tuberculosis (TB) is still a major public concern in Korea, there are few data on the management of TB patients and its outcome in the private sector in contrast with those of the public sector.

Methods : The nine-hundred-twelve TB patients who were registered in a private university hospital from 2001 to 2002 were enrolled. The patients were divided into pulmonary (TBP), extrapulmonary (TBE), and combined (TBP+E) groups, and were also divided into initial and retreatment groups. The clinical characteristics, diagnostic methods, treatment regimens, and outcomes were analyzed and compared between the groups.

Results : The mean age of 912 patients was 49.2 years and the male-to-female ratio was 56%:44%. The number of patients of the initial and retreatment groups of TBP, and those of (TBE+TBP+E) were 449, 169, 237, 57, respectively. The bacteriological study was performed in 97.9%, and positive culture was confirmed in 54.5% and 29.6% of patients with TBP and (TBE+TBP+E), respectively (P<0.05). The AFB smear was positive in 40.8% of TBP patients. The PCR was done in 63.6% of (TBE+TBP+E) group. The MDR was detected in 7.6% of isolates. Overall, treatment completion rate was 74.6%, default rate 13.7%, and death rate 0.5%.

Conclusion : Even though the management of TB patients in a private hospital was satisfactory in terms of national guidelines, the high default rate was still a problem. Efforts to decrease the default rate is needed independently or in cooperation with the public sector.
Key Words: tuberculosis, private sector, Korea, diagnosis, treatment, treatment outcome
연구배경 : 결핵은 아직도 우리나라에서 보건학적으로 중요한 문제임에도 불구하고 공공의료부문과 달리 민간의료부문에서의 결핵 환자 진료 실태는 잘 알려져 있지 않은 상황이다. 국내 민간병원에서의 결핵환자 진료 실태를 파악하고자 본 연구를 시행하였다.

방법 : 2001년에서 2002년 사이에 등록된 15세 이상의 결핵 환자 912명을 대상으로 후향적으로 의무기록을 분석하였다. 환자를 폐결핵과 폐외결핵, 초치료군과 재치료군으로 나누어 임상상, 진단방법, 약제감수성 검사 결과, 치료처방, 약제부작용 및 치료결과를 분석하였다.

결과 : 912명의 평균 나이는 49.2세, 남녀비는 56:44%였다. 폐결핵 초치료 및 재치료, 폐외결핵 초치료 및 재치료 환자는 각각 449, 169, 237, 57명이었고, 274명(30.0%)에서 기저질환이 동반되었다. 893명(97.9%)에서 세균학적 검사가 시행되었고 배양 양성은 폐결핵에서 337명(54.5%), 폐외결핵에서 87명(29.6%)이었다(P<0.05). 도말 양성 폐결핵은 40.8% (252/618)였다. 결핵균 PCR은 폐결핵의 18.3%, 폐외결핵의 63.6%에서 시행되었으며 양성률은 전체 환자 중 각각 5.0%와 34.0%였다(P<0.05). 다제내성결핵은 7.6% (21/278)에서 확인되었다. 전체 환자의 치료완료율은 74.6%였고, 배양 양성 폐결핵 환자에서의 완치율 및 치료완료율은 각각 54.9%와 16.3%였다. 전체 환자의 치료중단율은 13.7%, 사망률은 0.5%였다.

결론 : 서울 소재 한 민간대학병원에서의 결핵의 진단 및 치료는 국내 결핵관리지침에 부합할 뿐만 아니라 새로운 진단기법의 도입 등 만족할 만하였으나 중도 탈락 환자를 관리하지 못하는 단점이 확인되었다. 추후 중도 탈락 환자를 관리할 수 있는 방법의 개발이 필요하다.
중심 단어: 결핵, 민간의료기관, 대한민국, 진단, 치료, 치료성적


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