患肾功能受损与患肾无功能的肾结核患肾切除者临床表现与影像学表现对比  

Comparison of clinical and imaging findings in patients with renal function impairment and renal insufficiency in patients with renal tuberculosis

作　　者：王庆伟[1] 吉冠昌 吴军卫[1] 王焱[1] 张国贤[1] 任川川[1] 朱文[1] 车英玉[1] 贾智明 张晨阳[1] 文建国[1,2] WANG Qing-wei;JI Guan-chang;WU Jun-wei;WANG Wei;ZHANG Guo-xian;REN Chuan-chuan;ZHU Wen;CHE Ying-yu;JIA Zhi-ming;ZHANG Chen-yang;WEN Jian-guo(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pediatric Surgery,Xinxiang Medical University,Xinxiang 453100,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052 [2]新乡医学院小儿外科,河南新乡453100

出　　处：《河南医学研究》2019年第24期4428-4432,共5页Henan Medical Research

摘　　要：目的对比患肾功能受损与患肾无功能的肾结核患肾切除者临床表现与影像学表现。方法回顾性收集2012年1月至2018年12月于郑州大学第一附属医院行患肾切除病理证实为肾结核患者的临床资料,共101例。根据患侧肾动态扫描所测肾小球滤过率(GFR)将其分为患肾功能受损组(患肾GFR>20 mL/min)和患肾无功能组(患肾GFR≤20 mL/min)。分析两组患者的临床症状、实验室检查及影像学检查的特点。结果肾结核切除患者病程为0.1-108个月,两组患者LUTS症状、腰痛、肉眼血尿、发热、非发热全身症状比较,差异无统计学意义(均P>0.05)。实验室检查中尿常规异常者86(85.1%)例,其中以镜下血尿为主80(79.2%)例,结核特异性检查中T-SPOT阳性率最高(88.9%),结明三项次之(77.1%);两组患者实验室检查结果比较,差异无统计学意义(均P>0.05)。患肾功能受损组的肾皮质CT增强差值和肾皮质厚度高于患肾无功能组,且动脉期两组患肾CT增强值低于各自对侧肾(均P<0.001)。多数中晚期肾结核患者肾实质结核空洞形成与肾功能受损常同时存在。结论肾结核行患肾切除者,患肾功能受损程度与患肾皮质厚度、CT动脉期患肾增强程度成正相关,而与临床症状严重程度,尿常规、结明三项、T-SPOT等实验室检查指标严重程度,以及泌尿生殖系肾外器官受累程度无关。肾结核CT动脉期与对侧健肾相比,增强程度越低,其肾功能损害越严重。Objective To compare the clinical and imaging findings of patients with renal function impairment and renal insufficiency in patients with renal tuberculosis.Methods The clinical data of 101 patients with renal tuberculosis confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018 were collected.According to the glomerular filtration rate(GFR)measured by SPET-CT dynamic renal scan on the affected side,the patients were divided into two groups:the dysfunction group(GFR>20 mL/min)and the non-function group(GFR≤20 mL/min).To summarize the clinical symptoms,laboratory examinations and CT imaging features of all kidney tuberculosis patients,and compare the differences between the two groups.Results The course of renal tuberculosis resection was 0.1-108 months.There was no significant difference in LUTS symptoms,low back pain,hematuria,fever and non-febrile systemic symptoms between the two groups(all P>0.05).There were 86 cases(85.1%)with abnormal urine routine in laboratory examination,80 cases(79.2%)were mainly hematuria under microscope,the positive rate of T-SPOT was the highest in tuberculosis specific examination(88.9%),followed by Jieming three items(77.1%),and there was no significant difference between the two groups(all P>0.05).The difference of CT enhancement and the thickness of renal cortex in the group with renal function impairment were higher than those in the group without renal function,and the enhancement value of CT in the two groups in arterial phase was lower than that in the contralateral kidney(all P<0.001).In most patients with advanced renal tuberculosis,the formation of tuberculosis cavity in renal parenchyma and the impairment of renal function often occur at the same time.Conclusion Among the patients underwent nephrectomy for renal tuberculosis,the degree of renal function impairment was positively correlated with the thickness of renal cortex and the enhancement degree of renal in CT arterial phase,but not with the severity of cl

关 键 词：肾结核 临床特征 肾功能 计算机断层扫描 

分 类 号：R692[医药卫生—泌尿科学]