维持性血液透析患者结核杆菌感染的危险因素及诊治策略  

Risk factors, diagnosis and treatment of tuberculosis infection in maintenance hemodialysis patients

作　　者：秦瑜[1] 贾凤玉[1] 刘文渊[1] 景颖[1] 荣鹏[1] 王素霞[1] Qin Yu;Jia Fengyu;Liu Wenyuan;Jing Ying;Rong Peng;Wang Suxia.(Department of Blood Purification, Jinan Military District General Hospital of PIA, Jinan 250031, China)

机构地区：[1]济南军区总医院血液净化科,250031

出　　处：《国际移植与血液净化杂志》2018年第2期23-26,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的分析血液透析患者感染结核菌（tuberculosis，TB）的相关危险因素，为采取必要措施降低TB感染率提供理论依据。方法回顾分析2009年1月1日至2016年1月1日在济南军区总医院血液净化科接受维持性血液透析治疗的423例患者的临床资料，统计TB感染率，并分析结核菌感染与血液透析患者年龄、性别、透析龄、血红蛋白（Fib）、血清白蛋白（A1b）、有无使用免疫抑制剂、有无合并糖尿病、有无结核病接触史的关系。结果42例患者被诊断结核，感染率为9．93％，年龄〈60岁者，TB感染率为13．86％，年龄≥60岁者，TB感染率为6．33％，低于前者；透析龄〈5年的患者TB感染率为15．23％，透析龄≥5年的患者TB感染率为2．78％，低于前者。白蛋白〉140g／L的患者TB感染率是3．03％，白蛋白〈40g／L的患者TB感染率是16％，高于前者；无免疫抑制剂应用史的患者TB感染率是8．28％，有免疫抑制剂应用史的患者TB感染率是14．05％，高于前者；血红蛋白〉110g／L的患者TB感染率是4．95％，血红蛋白〈110g／L的患者TB感染率是13．69％，高于前者；差异均有统计学意义（P〈0．05）。女性患者TB感染率为9．63％，男性患者TB感染率是10．17％，高于女性；糖尿病患者TB感染率为7．81％，非患糖尿病患者TB感染率是10．85％，低于前者；无结核接触史的患者TB感染率为9．47％，有结核接触史的患者TB感染率为12．5％，高于前者；差异均无统计学意义（P〉0．05）。在结核患者中淋巴结核占38．1％，胸膜结核占21．43％，腹膜结核占16．67％，肺结核、脑结核、泌尿结核各占4．76％，骨结核占2．38％，有3例未查及明显结核部位，占7．14％。结论小于60岁、透析龄小于5年、白蛋白小于40g/L、血红蛋白小于110g／L、有免疫抑制剂应用史为维持性血液透析患者的高危因素。肺外结核（如�Objective To analyze the risk factors of tuberculosis（TB） infection in hemodialysis patients, and to provide theoretical basis for taking necessary measures to reduce the infection rate. Methods The clinical data of 423 hemodialysis patients in Hemodialysis Department of Jinan Military Region General Hospital from January 1st, 2009 to January 20th, 2016 were retrospectively analyzed. Recorded the infection rate of tuberculosis,and analysed the relationship of the age, sex, hemoglobin （Hb）, serum albumin （Alb）, whether the use of immunosuppressive agents, with or without diabetes mellitus, and with or without the history of exposure to tuberculosis. Results Forty-two patients were diagnosed with TB. The final TB infection rate was 9.93% .Age〈 60 years of TB infection rate was 13.86%, age≥60 years of TB infection rate was 6.33%, lower than the former; dialysis age 〈 5 years of tuberculosis infection rate of patients was 15.23%, duration of dialysis patients ≥5 years TB infection rate was 2.78%, lower than the former. The TB infection rate was 3.03% in patients with albumin 〉140 g/L, and the TB infection rate in albumin 〈 40 g/L was 16%, which was higher than the former; the TB infection rate in patients without a history of agents was 8.28 %. The TB infection rate in patients with a history of agents application was 14.05 %, which was higher than the former; the TB infection rate of hemoglobin 〉 110 g/L was 4.95% ; the TB infection rate of hemoglobin 〈 110 g/L was 13.69%, which was higher than the former; and the difference was statistically significant（ P 〈 0. 05）. The rate of TB infection in female patients was 9.63%. The rate of TB infection in men was 10.17%, which was higher than that in women. The infection rate in patients with diabetes was 7.81%. The TB infection rate in non-diabetic patients was 10.85 %, which was lower than the former. The TB infection rate of patients without history of tuberculosis exposure was 9.47%, and the TB infection rate of patients with history o

关 键 词：慢性肾脏病 结核 高危因素 

分 类 号：R692.5[医药卫生—泌尿科学]