异烟肼针对性预防肾移植受者结核潜伏感染的回顾性研究  

A retrospective study of isoniazid in prevention of latent tuberculosis infection in kidney transplant recipients

作　　者：刘俊志 曾军 徐媛 晁晟 牛玉林 LIU Junzhi;ZENG Jun;XU Yuan;CHAO Sheng;NIU Yulin(Department of Organ Transplantation,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院器官移植科,贵阳550004

出　　处：《实用医学杂志》2022年第13期1609-1613,共5页The Journal of Practical Medicine

基　　金：贵州省贵阳市科技计划项目(编号:20199139)。

摘　　要：目的探讨在具有高危结核潜伏感染(LTBI)的肾移植受者中异烟肼预防结核发生的有效性,并分析肾移植受者术后结核发生的危险因素。方法回顾分析592例肾移植受者临床资料,根据LTBI风险分层和预防方案,将592例受者分为LTBI高危预防组(53例)、高危不预防组(74例)和低危组(465例)。比较各组术后结核发生情况,并行Cox回归分析影响因素。结果592例肾移植受者术后发生结核共29例。LTBI高危不预防组术后发生25例结核,高危预防组术后无结核发生(33.8%vs.0,P<0.05),而低危组发生4例结核(33.8%vs.0.9%,P<0.05)。Cox回归分析结果显示,术前胸部影像学异常(OR=8.607,95%CI:3.202~23.134,P<0.001)是移植术后结核发生的独立危险因素。结论肾移植受者术前应该严格筛查结核感染因素,尤其对于胸部影像学检查异常患者。对高危LTBI患者术后采用异烟肼预防可明显降低结核发生率。Objective To investigate the efficacy of isoniazid in preventing tuberculosis in kidney transplant recipients with high risk of LTBI,and to identify the risk factors for tuberculosis in all kidney transplant recipients.Methods The clinical data of 592 renal transplant recipients were retrospectively analyzed.According to LTBI risk stratification and prevention program,592 recipients were divided into high-risk LTBI prevention group(n=53),high-risk non-prevention group(n=74),and low-risk group(n=465).The incidence of postoperative tuberculosis in each group was compared.Cox regression analysis was performed on the clinical data of 592recipients to compare the results.Results 29 patients developed tuberculosis infection after transplantation in 592recipients.There were 25 cases of tuberculosis infection in the high-risk group without prevention of LTBI,no tuberculosis occurred in the high-risk prevention group(33.8%vs.0,P<0.05),and 4 cases of tuberculosis occurred in the low-risk group(33.8%vs.0.9%,P<0.05).In Cox regression analysis,abnormal preoperative chest imaging(OR=8.607,95%CI:3.202~23.134,P<0.001)was an independent risk factor for tuberculosis after transplantation.Conclusions Renal transplant recipients should be screened for LTBI before transplantation,especially for patients with abnormal chest imaging examinations.Postoperative isoniazid prophylaxis in high-risk LTBI patients can significantly reduce the incidence of tuberculosis.

关 键 词：肾移植 结核 潜伏结核感染 异烟肼 预防 

分 类 号：R617[医药卫生—外科学] R619[医药卫生—临床医学]