肺結核の切除病巣内結核菌培養に関する共同研究

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The materials of this study consisted of 3356 resected specimens of pulmonary tuberculosis which had been treated with chemotherapy and were resected during the period from 1953 to 1968 at nine institutions in Japan. Cultivation of tubercle bacilli and drug sensitivity tests were carried out on 1055 cavities and 784 non-cavitary lesions among original treatment cases, and on 1025 cavities and 492 noncavitary lesions among re-treatment cases (Table 3). The strains were defined as resistant if there was equal growth of tubercle bacilli on culture media containing 10 mcg SM, 1 mcg PAS or 1 mcg 1NI-I. The results obtained were as follows: 1) The positive rate of bacilli in the re s ected foci decreased according to the duration of chemotherapy during the first one year but thereafter it increased with the prolonged duration of chemotherapy. 2) In case of the original treatment, the culture positive rate correlated with the duration of negative sputum (Table 6). 3) In case of the origi n al treatment, the tubercle bacilli were cultured from 105 out of 607 non-cavitary lesions (17.3 %) and 405 out of 866 cavities (46.8 %). The rate decreasd to 4.8 % and 21.3 %, respectively, in 146 non-cavitary lesions and 136 cavities, if the rate is calculated exclusively for the case showing negative sputum for more than 12 months. 4) The results on the re-treatment cases showed the same trend, but the c ulture positive rate was higher than that of the original treatment cases in every category divided by the duration of negative sputum and the character of the foci at the time of resection (Fig.2). 5) The culture positive rate of bacilli in the lesions were different according to the cl i n ical course of the disease up to the time of resection. Regardless of the character of lesions, cases showing radiological improvement during treatment revealed lower positive rate and cases showing increase in the size of lesion X-ray film during chemotherapy showed higher positive rate (Table 8). 6) A s shown in Table 9, the amount of bacilli cultivated from the cavitary lesions was bigger than that from non-cavitary lesions, and even amoung cases showing negative sputum for more than 6 months before operation, a large amount of bacilli were cultivated from the cavitary lesions. 7) Strains resistant to the primary drugs were not found from non-cavitary lesions which had been treated with the primary drugs for less than 6 months before operation, but they were frequently found from cavities as well as from non-cavitary lesions treated for more than 7 months before operation (Table 10). As shown in Table 11, the ra t e of bacilli cultured from resected specimens of pulmonary tuberculosis correlated with (1) the duration of negative sputum (2) the character of the foci both at the start of treatment and the time of the resection and (3) whether it is original treatment or re-treatment. Some sugg e stions regarding the suitable time for operation, the optimum duration of chemotherapy and the prognosis of the patient after chemotherapy might be obtained from the above-mentioned result.
日本結核病学会の論文

肺結核の切除病巣内結核菌培養に関する共同研究

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