6 7

295Cytokines in Tuberculous Pleurisy/K.Aoe et al.

is a tool to simultaneously measure abundance of various cytokines and is expected to be a very useful method to provide informations for understanding a feedback mechanism of cytokine network. It is needed to clear the immunity in pleural fluid and to establish the less invasive and more useful method to diagnose tuberculous pleurisy.

Key words : Tuberculous pleurisy, Diagnosis, Cytokine, INF-γ, Receiver operating characteristics curve, Cytometric bead array

Departments of 1Respiratory Medicine and 2Clinical Research, National Sanyo Hospital Respiratory Disease Center

Correspondence to : Keisuke Aoe, Department of Respiratory Medicine, National Sanyo Hospital Respiratory Disease Center, 685 Higashikiwa, Ube-shi, Yamaguchi 755_0241Japan. (E-mail : aoe＠sanyou-dr.jp)

－－－－－－－－ Review Article－－－－－－－－

DIAGNOSIS AND TREATMENT OF TUBERCULOUS PLEURISY｜With Special Reference to the Significance of Measurement of

Pleural Fluid Cytokines｜

1, 2Keisuke AOE, 1Akio HIRAKI, and 2Tomoyuki MURAKAMI

Abstract　Tuberculous pleurisy as well as malignant pleuritis is a representative disease presenting pleural effusion. The diagnosis of tuberculous pleurisy is made from examination of pleural effusion, but the sensitivity of smear or culture of Mycobacterium tuberculosis from pleural fluid is generally low. Although the pleural fluid concentration of adenosine deam-inase (ADA) is useful in terms of sensitivity or specificity, the value could be high in empyema or rheumatoid pleuritis. Thoracoscopic biopsy of pleura is more sensitive rather than conventional percutaneous needle biopsy, but is more invasive. Tuberculous pleural effusion is caused by delayed allergy which macrophage and T-helper 1 cells mainly relate and the stimuli of bacterial body consecutively induces T-helper 1 cytokines. Pleural fluid interferon-γ (INF-γ) is important not only in pathogenesis but also in diagnosis. We demonstrated that INF-γ is a more sensitive and specific indicator for tuberculous pleurisy than ADA using receiver operating characteristics (ROC) analysis. Cytometric bead array (CBA)

12

Abstract　[Purpose] To examine the clinical features of ultra-old patients over 85 years of age who were admitted to our hospital for tuberculosis treatment.　[Methods] Clinical features of tuberculosis patients over 85 years of age who were admitted to our hospital from January, 1996 to May, 2003 were analyzed in relation to their disease status, complications and prognosis.　[Results] They showed a high tuberculin negative rate (26.2％) and a low rate of cavity formation (21.8％), and the smear positive rate of tubercle bacilli was not high (51.2％). As to the complications, cerebrovascular disorders were overwhelm-ingly high (62.2％) and the death rate due to side effects of drugs was high. The sputum smear positive rate was higher (70％) among patients from nursing home.

　[Conclusion] The diagnosis of tuberculosis was often delayed with high mortality rate due to side effects of drugs among ultra-old patients and tuberculosis infection control measures to contacts are often needed.

Key words : Ultra-old tuberculosis, Disease status

Department of Pulmonary Medicine, National Matsue Hos-pital

Correspondence to : Shuichi Yano, Department of Pulmonary Medicine, National Matsue Hospital, 5_8_31, Agenogi, Matsue-shi, Shimane 690_8556 Japan. (E-mail : yano＠matsue.hosp.go.jp)

－－－－－－－－ Original Article－－－－－－－－

THE CLINICAL FEATURES OF ULTRA-OLD TUBERCULOSIS PATIENTSIN OUR HOSPITAL

Shuichi YANO, Kanako KOBAYASHI, Kazuhiro KATO, Masato MORITA, Toshiyuki TATSUKAWA, and Toshikazu IKEDA

の割合が高く発見が遅れやすい。また合併症を有してお

り，発見の遅れと副作用の出現と相俟って死亡率も高率

であると考えられた。感染対策上も超高齢者結核の早期

診断・早期治療とともに副作用に対する細心の注意が重

要であると考えられた。

文　　　献

1） 平成14年簡易生命表. 厚生労働省大臣官房統計情報部. 2003年7月11日公表.

2） 小澤利男：「エッセンシャル老年病」第 2版, 医歯薬出版, 東京, 1995.

3） 小澤利男, 折茂肇編著：「高齢者薬物療法ハンドブック」. 中外医学社, 東京, 2002.

4） 平成14年10月 1日現在推定人口. 総務省統計局. 2003年 3月14日公表 .

5） 平成12年 9月14日現在人口. 総務省統計局. 2001年 9月14日公表.

6） 平成14年結核発生動向調査年報集計結果について.「結核の統計2003」, 39.

7） 毛利昌史, 町田和子, 川辺芳子, 他,：国立療養所における高齢者結核の現状. 結核. 2001 ; 76 : 533_543.

8） 藤岡正信, 山本正彦：老人結核の臨床疫学的研究. 結核. 1980 ; 55 : 557_560.

9） 倉澤卓也, 新実彰男, 加藤元一, 他：初回治療結核患者の胸部 X線所見. 結核. 1986 ; 61 : 557_565.

10） 佐々木結花, 山岸文雄, 鈴木公典, 他：超高齢者肺結核の臨床的検討. 結核. 1992 ; 67 : 545_598.

11） Van den Brande P, Demedts M : Four-stage tuberculin testing in elderly subjects induces age-dependent progressive boosting. Chest. 1992 ; 101 (2) : 447_450.

12） 石橋凡雄, 原田泰子, 高本正祇, 他：リンパ球サブセットの正常値及び加齢に伴う変動. 結核. 1987 ; 62 : 647_

654.13） 原田　進, 高本正祇, 原田泰子, 他：高齢者結核の臨

床免疫的検討. 結核. 1989 ; 64 : 529_536.14） 横山俊伸, 力丸　徹, 合原るみ, 他：困難な条件下で

の結核治療｜高齢者における結核治療. 結核. 2003 ; 78 : 479_482.

結核 第79巻 第 4号 2004年 4月300

18 19

Abstract　[Objectives] To clarify features of thoracic malig-nancies occurred in patients with chronic tuberculous empyema.　[Materials and methods] We analyzed clinicopathological data of 15 patients with thoracic malignancies who had chronic tuberculous empyema, encountered at Tokyo National Hospital during the period from 1977 to 2002.　[Results] There were 13 men and 2 women, with a mean age of 67 years. Most of all (13/15) patients had history of surgery for tuberculosis including artificial pneumothorax (9 cases).Malignancies consisted of pyothorax-associated lymphoma (PAL ; 9 cases), lung cancer (4 cases), malignant fibrous histiocytoma (1 case), and angiosarcoma (1 case). There were no differences in background factors between PAL patients and the other patients. Common symptoms were chest pain (10 cases), fever (7 cases), and bloody sputum (4 cases) and it seemed that these symptoms were more evident in patients with PAL than in patients with other diseases. Plain chest X-ray films often failed to detect the tumor, and the diagnosis was often obtained by sputum cytology, bronchofiberscopy, transcutaneous biopsy, and resection with support of CT and/or MRI films. On radiographs, all tumors located in

empyema cavities or around empyema walls, and a pulmonary mass adjacent to the empyma wall was characteristic of lung cancer. PAL showed certainly good outcome ; 40％ 5-year survival rate with resection or chemoradiotherapy. On the other hand, all of lung cancer cases were diagnosed at stage III, and had poor outcome, and the remaining patients with the other malignancies also had poor outcome. 　[Conclusion] Clinicians should keep in mind occurrence of several thoracic malignancies during the follow-up of patients with chronic tuberculous empyema.

Key words : Chronic tuberculous empyema, Thoracic malig-nancies, Pyothorax-associated lymphoma, Lung cancer

1Department of Respiratory Diseases, and 2Pathology, Tokyo National Hospital

Correspondence : Atsuhisa Tamura, Department of Respira-tory Diseases, Tokyo National Hospital, 3_1_1, Takeoka, Kiyose-shi, Tokyo 204_8585 Japan. (E-mail : tamura＠tokyo.hosp.go.jp)

－－－－－－－－ Original Article－－－－－－－－

THORACIC MALIGNANCIES IN PATIENTS WITH CHRONICTUBERCULOUS EMPYEMA

1Atsuhisa TAMURA, 2Akira HEBISAWA, 1Yuzo SAGARA, 1Junko SUZUKI,1Kimihiko MASUDA, 1Motoo BABA, 1Hideaki NAGAI, 1Shinobu AKAGAWA,

1Naohiro NAGAYAMA, 1Yoshiko KAWABE, 1Kazuko MACHIDA, 1Atsuyuki KURASHIMA,1Hikotaro KOMATSU, and 1Hideki YOTSUMOTO

Malignancy in Chronic Empyema/A.Tamura et al. 307

27） Conway EJ, Hudnall SD, Lazarides A, et al. : Absence of evidence for an etiologic role for Epstein-Barr virus in neoplasms of the lung and pleura. Mod Pathol. 1996 ; 9 : 491_495.

28） Wong MP, Chung LP, Yuen ST, et al. : In situ detection of Epstein-Barr virus in non-small cell lung carcinomas. J Pathol. 1995 ; 177 : 233_240.

29） Kasai K, Sato Y, Kameya T, et al. : Incidence of latent infec-tion of Epstein-Barr virus in lung cancers─ an analysis of EBER1 expression in lung cancers by in situ hybridization. J Pathol. 1994 ; 174 : 257_265.

30） Hayakawa H, Shirai M, Uchiyama H, et al. : Lack of evi-

dence for a role of Epstein-Barr virus in the increase of lung cancer in idiopathic pulmonary fibrosis. Respir Med. 2003 ; 97 : 281_284.

31） Shibata D, Weiss LM : Epstein-Barr virus-associated gastric adenocarcinoma. Am J Pathol. 1992 ; 140 : 769_774.

32） 山中　晃, 高橋憲太郎, 加藤弘文, 他：膿胸壁に接した胸壁原発 malignant fibrous histiocytoma. 肺癌. 1986 ; 26 : 699_705.

33） Kimura M, Ito H, Furuta T, et al. : Pyothorax-associated an-giosarcoma of the pleura with metastasis to the brain. Pathol Int. 2003 ; 547_551.

23

Abstract　[Purpose] To investigate the usefulness of measur-ing C-reactive protein in the diagnosis of lung tuberculosis.　[Object] Tuberculosis patients treated by chemotherapy at Fukujuji Hospital from Jan. /1/2000 to Dec. /31/2001.　[Method] Chart review.　[Results] CRP are negative in 13.3％ (95％CI : 8.9_17.7％) in sputum smear positive lung tuberculosis patients (N＝226), and in 73.0％ (95％CI : 62.0_84.0％) of sputum smear nega-tive culture positive lung tuberculosis patients (N＝63).　[Conclusion] Usefulness of measuring C-reactive protein in the diagnosis of bacteriological positive lung tuberculosis is limited.

Key words : Active lung tuberculosis, Erythrocyte sedimen-tation rate, C-reactive protein (CRP), Leukocytosis

1Department of Research, Research Institute of Tuberculosis, 2Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association

Correspondence to : Kunihiko Ito, Department of Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_

8533 Japan. (E-mail : ito＠jata.or.jp)

－－－－－－－－ Short Report－－－－－－－－

C-REACTIVE PROTEIN IN PATIENTS WITH BACTERIOLOGICALPOSITIVE LUNG TUBERCULOSIS

1Kunihiko ITO, 1Takashi YOSHIYAMA, 1Masako WADA, and 2Hideo OGATA

311CRP and Lung Tuberculosis /K.Ito et al.

文　　　献

1） 三友義雄：「血沈」, 南江堂, 東京, 1951.2） 柳澤直志, 高橋光良, 並木雅彦, 他：肺結核患者の赤血球沈降反応についての検討. 感染症学雑誌. 1996 ;

70 : 955_961.3） 鈴木　清, 高島光良, 山田　孝, 他：肺結核化学療法経過観察時における血清急性相反応物質の量的変動.結核. 1992 ; 67 : 303_311.

32

Abstract　Mycobacterium xenopi is very rare pathogen in Japan. We reported herein four cases of M.xenopi pulmonary disease. These patients were all male and their ages ranged from 53 to 72. They all had past history of pulmonary tuber-culosis, including two cases who had been also treated for Mycobacterium kansasii pulmonary disease later. The bacilli could be cultured in Mycobacteria Growth Indicator Tube (MGIT) system from 10 sputum samples, but they could not be cultured on Ogawa egg media except for two samples. All four cases fulfilled the criteria for the diagnosis of nontuber-culous mycobacteria pulmonary disease proposed by the Japa-nese Society for Tuberculosis. Combination chemotherapy including isoniazid, rifampicin, and ethambutol was started in all four cases when mycobacteria were detected under tenta-tive diagnosis of the relapse of tuberculosis or Mycobacterium kansasii disease. Sputum converted to culture negative by the

chemotherapy in two cases. In one case, the chemotherapeutic regimen was changed to rifampicin, ethambutol, and clarithro-mycin after the bacteriological identification of M.xenopi, and the new regimen was found to be effective. In the final case, both of the regimens were finally ineffective.

Key words : Mycobacterium xenopi, Nontuberculous myco-bacteria

Department of Respiratory Medicine, National Kinki-Chuo Hospital for Chest Diseases

Correspondence to : Seigo Minami, Department of Respira-tory Medicine, National Kinki-Chuo Hospital for Chest Diseases, 1180, Nagasone-cho, Sakai-shi, Osaka 591_8025Japan.

－－－－－－－－ Case Report－－－－－－－－

FOUR CASES OF MYCOBACTERIUM XENOPI PULMONARY DISEASE

Seigo MINAMI, Katsuhiro SUZUKI, Kazunari TSUYUGUCHI, and Mitsunori SAKATANI

結核 第79巻 第 4号 2004年 4月320

43

訂　　　正

先に掲載した下記の論文について，タイトルは「老健施設」ではなく「特別養護老人ホーム」ではないか，との指摘を

受けました。

結核第77巻第 5号401頁_408頁，2002

近藤有好他：老健施設における結核の外来性再感染と思われる集団発生について

編集委員会では指摘のとおりであることを著者に確認しました。以後本誌ではこの論文での「老健施設」は「特別養護

老人ホーム」という理解で扱うことにします。お詫びして訂正します。

なお，英文は訂正の必要はないと判断しました。　　　　　　　　　　　　　　　　　　　　　　　　（編集委員会）

訂　　　正

先に掲載した下記の論文について，引用文献で誤りがありましたので，お詫びして訂正します。　　　（編集委員会）

結核第78巻第12号723頁_732頁，2003

佐々木結花他：肺結核再治療例の検討

文献26は以下のように訂正します。

Abe C, Hirano K, Wada M, et al. : Resistance of Mycobacterium tuberculosis to four first-line anti-tuberculosis drugs in Japan,

1997. Int J Tuberc Lung Dis. 2001 ; 5 : 46_52.

ERRATUM

Kekkaku Vol. 78, No. 12 : 723_732, 2003

Original Article

Yuka SASAKI, et al. : A Study on Pulmonary Tuberculosis Retreatment Cases

Reference No. 26 should have been as follows,

Abe C, Hirano K, Wada M, et al. : Resistance of Mycobacterium tuberculosis to four first-line anti-tuberculosis drugs in Japan,

1997. Int J Tuberc Lung Dis. 2001 ; 5 : 46_52.

We apologize for any confusion.

Kekkaku Vol. 79, No. 4 331