终末期肾病维持性血液透析患者并发肺结核与肺外结核的临床特点  

Clinical analysis of pulmonary tuberculosis and extrapulmonary tuberculosis complicated in maintenance hemodialysis patients with end-stage renal disease

作　　者：任瑞霖 张五星[2] 周伟[2] 汪杨[2] 黄巍[2] Ren Rui-Lin;Zhang Wu-Xing;Zhou Wei;Wang Yang;Huang Wei(Graduate School of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Nephrology,the 8th Medical Center of Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]河北北方学院研究生院,河北张家口075000 [2]解放军总医院第八医学中心肾内科,北京100091

出　　处：《解放军医学杂志》2021年第3期274-279,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨终末期肾病维持性血液透析患者并发肺结核(PTB)和肺外结核(EPTB)的临床特点。方法选择2012年7月-2021年2月在解放军总医院第八医学中心结核科就诊并在血液净化中心行维持性血液透析治疗的终末期肾病并发结核病患者共133例,分为PTB组(n=87)与EPTB组(n=46),对比分析两组患者的临床特点及预后情况。结果PTB组及EPTB组均以男性为主(80.5%vs.58.7%),但EPTB组的女性比例(41.3%)较PTB组(19.5%)更高(P<0.05)。两组的年龄、肾脏原发病、合并疾病、透析时间、透析后结核检出时间差异无统计学意义。出现的首发症状中,PTB组咳嗽咳痰(59.8%)及发热(60.9%)比例明显高于EPTB组(分别为23.9%、28.3%,P<0.05),而病变部位疼痛比例明显低于EPTB组(8.0%vs.41.3%,P<0.05)。PTB组及EPTB组的确诊方式均以CT或MRI影像学检查为主(67.8%vs.76.1%),其次分别为痰涂片或培养(26.4%vs.6.5%)及穿刺活检(5.7%vs.17.4%),两组间差异均有统计学意义(P<0.05)。两组γ干扰素释放试验阳性率差异无统计学意义。PTB组与EPTB组中淋巴细胞、血红蛋白、白蛋白降低的比例,以及红细胞沉降率、C-反应蛋白升高的比例均较高,但组间差异无统计学意义。两组均行抗结核药物治疗,EPTB组1例在抗结核药物治疗的基础上行结核灶清除手术治疗。两组不良反应发生率差异无统计学意义,治疗好转率相似。结论终末期肾病维持性血液透析的PTB与EPTB患者在性别比例、首发症状及确诊方式方面存在明显差异,重视这些差异,进行个体化监测和诊治,将有助于降低PTB及EPTB的发病率及病死率。Objective To explore the clinical features of patients with end-stage renal disease(ESRD)complicated with pulmonary tuberculosis(PTB)and extrapulmonary tuberculosis(EPTB)and undergoing maintenance hemodialysis(MHD).Methods A total of 133 ESRD patients complicated with tuberculosis,treated at the Tuberculosis Department of the 8th Medical Center of Chinese PLA General Hospital and undergoing MHD at the Blood Purification Center,were selected from July 2012 to February 2021,and divided into PTB group(87 cases)and EPTB group(46 cases).The clinical characteristics,treatment and prognosis of the two groups were compared and analyzed.Results Both PTB group and EPTB group were predominantly male patients(80.5%and 58.7%),but the proportion of female patients was higher in EPTB group(41.3%)than that in PTB group(19.5%,P<0.05).No significant differences existed between the two groups in age,primary kidney disease,comorbidities,dialysis duration,and the detection time-point of tuberculosis after dialysis.Among the first symptoms,the proportion of cough+sputum and fever was significantly higher in PTB group than that in EPTB group(59.8%vs.23.9%and 60.9%vs.28.3%,respectively,P<0.05),while the proportion of pain at lesion location was significantly lower in PTB group than that in EPTB group(8.0%vs.41.3%,P<0.05).CT or MRI imaging was the dominated method for definite diagnosis in both PTB group and EPTB group(67.8%and 76.1%),the secondary method was sputum smear or culture(26.4%and 6.5%)and needle biopsy(5.7%and 17.4%),respectively,with a significant difference between the two groups(P<0.05).No significant difference existed in the positive rate ofγ-interferon release assay(γ-IRA)between the two groups.In both PTB group and EPTB group,the proportion of lymphocytes,hemoglobin and albumin decreased markedly,while the proportion of erythrocyte sedimentation rate(ESR)and increased C-reactive protein(CRP)were relatively higher,but there was no statistical difference between the two groups.Both groups were treated with antitubercul

关 键 词：终末期肾病 维持性血液透析 肺结核 肺外结核 

分 类 号：R521[医药卫生—内科学] R692.6[医药卫生—临床医学]