不典型中晚期肾结核31例临床分析  

CLINICAL ANALYSIS OF 31 CASES OF ATYPICAL MID-ADVANCED STAGE RENAL TUBERCULOSIS

作　　者：杨镜秋[1] 田生平[1] 章振保[1] 杨庆涛[1] 

机构地区：[1]汕头大学医学院第二附属医院,广东汕头515041

出　　处：《现代医院》2007年第8期20-21,共2页Modern Hospitals

摘　　要：目的探讨导致中晚期肾结核发生的原因及其诊断方法。方法回顾性分析31例经病理诊断的中晚期肾结核患者临床资料。结果有典型的膀胱刺激症患者只占29.03%,83.37%患者有血尿、19.35%患者有腰痛,腰痛伴间断发热者占16.13%;有结核中毒症状者占19.35%。尿常规异常者占93.55%,结核杆菌检测阳性率为22.58%,PCR-TB阳性率为61.29%。B超检查31例、CT26例、IVP31例,诊断肾结核符合率分别为19.35%、61.29%、92.31%。其中25例IVP(57.14%)患肾不显影,肾功能已丧失,行肾切除,另6例经抗痨治疗后均治愈。结论肾结核临床症状不典型化以及早期缺乏明显的影像学改变,是导致中晚期肾结核发生的重要原因。肾结核的诊断必须重视其不典型性的临床症状,对实验室检查及其影像学结果进行综合分析,以期提高早期诊断率。Objective To approach the cause and the diagnostic method of mid - advanced renal tuberculosis. Method To retrospectively analyze the clinical data of 31 cases that has been undergone pathological diagnosis of mid - advanced renal tuberculosis. Result Of all the 31 cases, only 29.03% of the patients had the typical irritative symptoms of bladder; 83.37% of the patients had haematuria; 19.35% of the patients suffered lumbar myalgia; 16.13% of the patients had lumbar myalgia accompanied by intermittent fever; 19.35% of the patients showed tuberculosis toxic symptoms. The urine routines of 93.55% patients were abnormal; the positive rates of tuberculosis bacillus detection were 22.58%; the positive rates of PCR- TB were 61.29%. CT exam of 26 cases, β -type ultrosonography and IVP exam of 31 cases indicated that the coincidence rate of renal tuberculosis was respectively 19.35%, 92.31% and 61.29%. The affected kidneys of 25 cases with IVP showed nonvisualization which suggesting renal function loss. 25 cases of nephrectomy were performed. 6 cases that had undergone antitubereulotic treatment were all healed. Conclusion The atypical clinical symptoms and the early stage insufficiency of overt imagine changes of renal tuberculosis are the important reasons that have led to the mid - advanced renal tuberculosis. The atypical clinical symptoms must be emphasized if the diagnosis of renal tuberculosis is made. The laboratory examination and the imagine results should be analyzed aggregately in order to improve the early stage diagnostic rate.

关 键 词：肾 结核 诊断 

分 类 号：R527.1[医药卫生—内科学]