肾移植术后肺结核及肺外结核的诊治  

Treatment of pulmonary tuberculosis and extrapulmonary tuberculosis after renal transplantation

作　　者：方佳丽[1] 陈正[1] 马俊杰[1] 李光辉[1] 张磊[1] 徐璐[1] 艾威[1] 李德胜[1] 谢斯盛[1] 朱景辉[1] 潘光辉[1] 

机构地区：[1]广州医学院第二附属医院器官移植科,广东广州510260

出　　处：《实用医院临床杂志》2011年第6期11-14,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨肾移植术后肺内和肺外结核的诊断和治疗方法及其预后。方法对我院2000年2月至2011年7月肺内、外结核感染的患者进行总结分析。治疗方案采用四联抗结核药物;同时足量使用CNI类药物。复查肝肾功能及CNI药物浓度,CT平扫。观察患者感染类型,临床表现,病原体检出情况,影像学情况,肝肾功能及CNI药物剂量及浓度,不良反应及转归等指标。结果共收治结核患者18例,发病率1.52%,病原体检出率低,影像学表现多样不典型,需与其他病原体相鉴别。14例完成抗结核治疗,4例仍在治疗中,肾功能可基本稳定。CNI类药物浓度在使用抗结核治疗过程中明显下降,均未出现急性排斥反应。结论肺结核的诊断需结合影像学特点及病原学资料;肺外结核的诊断应注重病原体的检出。治疗需坚持联合、足量、足疗程抗结核治疗原则,选择适宜的服药时间,同时适当调整免疫抑制剂的用量,可获得理想的疗效。Objective To discuss the diagnosis,treatment and prognosis of pulmonary tuberculosis and extrapulmonary tuberculosis after renal transplantation.Methods We analyzed patients with pulmonary tuberculosis and extrapulmonary tuberculosis in our hospital from Feb 2000 to Jul 2011.The combination of 4 antituberculosis drugs and sufficient CNI drugs were used.Fuction of liver and kidney,concentration of CNI drugs and CT noncontrast enhanced scan were rechecked.We observed the infection type,clinical manifestation,detection of pathogen,imaging,liver and renal function,the dosage and concentration of CNI drugs,adverse effect and prognosis.Results The morbidity of tuberculosis among the 18 patients was 1.52%.The detection rate of pathogen was low.The pathogen should be further differentiated from others due to atypical imaging.No acute rejection was observed.Conclusions Imaging and etiology data should be considered in the process of diagnosis.We should pay attention to the detection of pathogen,adhere to the principle of combination,sufficiency and enough course of treatment,choose appropriate time of taking medicine,adjust the dosage of immunosuppressive agent to gain an ideal curative effect.

关 键 词：肺结核 肺外结核 肾移植 手术后 

分 类 号：R521[医药卫生—内科学] R699.2[医药卫生—临床医学]