终末期肾病维持性血液透析患者并发病原学阳性和阴性肺结核的临床特点及预后分析  

Clinical characteristics and prognosis analysis of patients with end-stage renal disease in maintenance hemodialysis and complicated with pathogen-positive and-negative pulmonary tuberculosis

作　　者：王妙琴 任瑞霖 张五星[2] 周伟[2] 汪杨[2] 黄巍[2] Wang Miao-Qin;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学院,河北张家口075000 [2]解放军总医院第八医学中心肾脏病科,北京100091

出　　处：《解放军医学杂志》2022年第4期375-381,共7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病原学阳性和阴性肺结核的临床特点及预后情况。方法收集2012年7月-2022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98例终末期肾病并发肺结核患者,根据痰涂片、痰结核分枝杆菌培养及分子生物学诊断结果分为病原学阳性组(n=34)与病原学阴性组(n=64),对比分析两组的临床特点、治疗效果及预后情况。结果肺结核病原学阳性与阴性组均以男性(分别为85.3%、76.6%)和中老年人[分别为(56.4±15.6)岁、(55.8±15.0)岁]为主。与病原学阴性组比较,病原学阳性组基础病非原发性肾小球肾炎的比例(38.2%vs.17.2%)和首发症状为咳嗽咳痰的比例(91.2%vs.50.0%)高(P<0.05)。实验室检查结果显示,病原学阳性组白细胞、中性粒细胞、单核细胞计数,中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)及C反应蛋白水平均高于病原学阴性组(P<0.05),但淋巴细胞计数低于病原学阴性组(P<0.05)。胸部CT显示,与病原学阴性组比较,病原学阳性组胸膜增厚、空洞形成比例高(P<0.05),条索影比例低(P<0.05)。两组抗结核治疗的疗效均较好(94.1%vs.95.3%)。多因素logistic回归分析结果显示,咳嗽咳痰(OR=12.572,95%CI 2.609~60.581)、MLR(OR=8.226,95%CI 2.479~27.298)、合并胸膜增厚(OR=4.740,95%CI 1.043~21.541)及空洞形成(OR=8.462,95%CI 2.423~29.555)为肺结核患者病原学阳性的独立危险因素。结论终末期肾病维持性血液透析并发病原学阳性及阴性肺结核患者的临床特点存在差异,以咳嗽咳痰为首发症状、MLR、合并胸膜增厚及空洞形成是肺结核病原学阳性的独立危险因素。Objective To explore the clinical characteristics and prognosis of patients with end-stage renal disease(ESRD)in maintenance hemodialysis(MHD)and complicated with pathogen-positive and-negative pulmonary tuberculosis.Methods A total of 98 ESRD patients complicated with pulmonary tuberculosis,admitted in the Tuberculosis Department and undergone MHD at the Blood Purification Center of the 8th Medical Center of PLA General Hospital from July 2012 to February 2022,were collected,and divided into pathogen-positive group(n=34)and pathogen-negative group(n=64)according to the results of sputum smear,sputum culture of Mycobacterium tuberculosis and molecular biological diagnosis.The clinical characteristics,therapeutic effect and prognosis of the two groups were compared and analyzed.Results Both the pathogen-positive and-negative pulmonary tuberculosis groups were mainly the males(85.3%and 76.6%,respectively)and middle-aged and elderly people[(56.4±15.6)years old and(55.8±15.0)years old,respectively].The proportion of patients with non-primary glomerulonephritis as main underlying kidney disease,and with cough and sputum as the first manifested symptom,were both higher in pathogen-positive group than in pathogen-negative group(38.2%vs.17.2%and 91.2%vs.50.0%,respectively)(P<0.05).The laboratory results showed that the leukocyte,neutrophil,monocyte count,neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR)and C-reactive protein level were higher,while the lymphocyte count was lower in pathogen-positive group than in pathogen-negative group(P<0.05).The chest CT found that the proportion of pleural thickened and cavity formation was higher(P<0.05),while of strip shadow was lower(P<0.05)in pathogen-positive group than in pathogen-negative group.The efficacy of anti-tuberculosis treatment was better in the both groups(94.1%vs.95.3%).Multivariate logistic regression analysis found that cough and sputum(OR=12.572,95%CI 2.609-60.581),MLR(OR=8.226,95%CI 2.479-27.298),pleural thickening(OR=4.740,95%CI 1.043-21.541)an

关 键 词：终末期肾病 维持性血液透析 肺结核 病原学阴性 病原学阳性 

分 类 号：R521[医药卫生—内科学]