肾移植术后肺结核确诊病例诊断与治疗的临床分析  

Clinical analysis of pulmonary tuberculosis infection in renal transplantation recipients

作　　者：郑龙[1] 王继纳 戚贵生[1] 李龙 张潮 许明[1] 戎瑞明[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032 [2]上海市器官移植重点实验室

出　　处：《中华器官移植杂志》2015年第11期666-670,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金（81500570）

摘　　要：目的 探讨肾移植术后肺结核的诊断与治疗.方法 回顾性分析2008-2014年在复旦大学附属中山医院接受诊治的8例肾移植术后肺结核患者的临床资料.结果 发热、咳嗽、咳痰是肾移植术后肺结核患者的常见症状.混合感染在肾移植术后肺结核病例中较为常见（8例中6例存在）.8例的结核菌素试验均为阴性,1例患者通过痰液抗酸杆菌涂片确诊,6例患者经纤维支气管镜肺泡灌洗或肺活检确诊,1例患者经胸腔镜活检确诊.患者确诊后均接受异烟肼＋利福平＋乙胺丁醇或吡嗪酰胺的三联初始抗结核治疗,并下调免疫抑制剂用量.随访12个月以上,肺结核病灶转归良好,未出现急性排斥反应、肝功能异常等不良事件.结论 肾移植术后肺结核的临床表现不典型,常规病原学检查阳性率低,纤维支气管镜及胸腔镜等有创检查可显著提高肾移植术后肺结核的诊断率.明确诊断后尽早进行规范抗结核治疗,并合理调整免疫抑制剂可获得良好的预后.Objective To investigate the diagnosis and treatment of pulmonary tuberculosis in renal transplantation recipients.Method The clinical data of 8 renal transplantation recipients suffering from pulmonary tuberculosis infection were retrospectively analyzed.Result Fever,cough and expectoration were the most common symptoms,however,lacking typicality.Images of chest Xray and CT scan were various and couldn＇t verify TB infection from pneumonia.Seven of 8 cases were diagnosed through invasive methods,either bronchofibroscope or fiberthoracoscopy.Immunosuppressants were decreased in all cases.Three-drug regimens,including isoniazide,rifampicin and ethambutol or pyrazinarnide,were administrated as anti-tuberculosis chemotherapy.All the cases were cured,without episodes like acute rejection and liver function impairment.Conclusion Routine examinations are not sufficient to diagnose pulmonary tuberculosis in kidney transplantation recipients.While,invasive methods like bronchofibroscope and fiberthoracoscope are helpful.When diagnosed,patients should receive normative anti-tuberculosis treatment and immunosuppressive agents adjustment,which can benefit the prognosis of pulmonary tuberculosis in renal transplantation recipients.

关 键 词：肾移植 结核 纤维支气管镜 胸腔镜 结核菌素试验 

分 类 号：R699.2[医药卫生—泌尿科学] R521[医药卫生—外科学]