血液透析患者结核菌感染的临床诊治分析  

Clinical diamlosis and trealment of tuberculosis complicated in maintenance hemodialysis patients

作　　者：杜胜华[1] 张琥[1] 郭琼芳[1] 张李刚 张春天[1] 

机构地区：[1]湖北省黄石市爱康医院肾内科,435000

出　　处：《国际移植与血液净化杂志》2012年第2期26-28,共3页International Journal of Transplantation and Hemopurification

基　　金：湖北省黄石市医药卫生科研立项基金资助项目（201032）

摘　　要：目的分析维持性血液透析患者感染结核菌的临床特点。方法回顾分析2008年1月至2010年8月我科12例维持性血液透析并发结核菌感染患者的临床资料、诊治及转归的情况。结果196例维持性血液透析患者中感染结核菌12例（6％）。其中肺结核3例（25％）、结核性胸膜炎4例（33％）、颈部淋巴结核及腹膜后淋巴结核各1例（8％）、部位不明的肺外结核3例（25％）。主要症状有发热、乏力、纳差等。结核菌素试验检查9例阴性，3例弱阳性；红细胞沉降率治疗前为（90±28）mm／h，治疗后为（47±18）mm／h，其中4例患者〉100mm／h；经抗结核治疗后患者红细胞沉降率、血红蛋白水平与治疗前比较差异有统计学意义（P〈0．05），血红蛋白水平也恢复明显（t=2．15，P〈0．05），并且所有患者治疗前、后未见药物不良反应发生。结论维持性血液透析患者合并结核菌感染临床较为常见，临床症状不典型、多以肺外结核为主，合理抗结核用药及疗程可改善患者的预后。Objective To analyze clinical features, treatment of tuberculosis infection in maintenance hemodialysis patients. Methods During the period from January in 2008 to August in 2010, 12 tuberculosis cases were found in the 196 maintenance hemodialysis patients in our hemodialysis center. Their clinical, laboratory and medical imaging data were collected and their clinical features, diagnosis, treatment and outcome were retrospectively analyzed. Results The 12 cases （6%） had three cases of pulmonary tuberculosis, four cases of tuberculous pleurisy, three cases of unknown orion, lymph node tuberculosis, cervical lymphadenopathy and retroperitoneal lymphadenopathy in one case. Tuberculin test （PPD） were negative in nine cases, and positive in 3 cases weakly. Erythrocyte sedimentation rate and blood globulin increased si- gnificantly, and decreased significantly （ P 〈 0.05） after Anti-tuberculosis. At the same time, the HGB significantly restored （ t = 2.15, P 〈 0.05）. no adverse drug reaction. Conclusion Clinical TB infection is more common and clinical symptoms are not typical in hemodialysis patients. Extrapulmonary tuberculosis is frequently encountered, rational anti-tuberculosis drugs and treatment can improve the prognosis of patients.

关 键 词：血液透析 结核 感染 

分 类 号：R52[医药卫生—内科学]