不典型肾结核56例诊治分析  

Analysis on diagnosis and treatment of 56 cases of atypical renal tuberculosis

作　　者：李崇斌[1] 尹航[1] 范正超[1] 刘建震[1] 朱晓黎[2] 黄天浩 LI Chongbin;YIN Hang;FAN Zhengchao;LIU Jianzhen;ZHU Xiaoli;HUANG Tianhao(Department of Urological Surgery,Hebei Provincial Chest Hospital,Shijiazhuang,Hebei 050041,China;Fourth Department of Chest,Hebei Provincial Chest Hospital,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院泌尿外科,石家庄050041 [2]河北省胸科医院胸四科,石家庄050041

出　　处：《重庆医学》2023年第2期190-194,共5页Chongqing medicine

基　　金：河北省卫生健康委员会青年科技课题项目(20170415)。

摘　　要：目的探讨不典型肾结核的诊治经验。方法分析该院泌尿外科2015年11月至2022年2月诊治的56例不典型肾结核患者的病历资料。结果首次就诊原因为体检发现不同程度肾积水或肾脏多发囊性病变32例,轻微的尿频、尿痛19例,患侧腰腹部酸胀不适3例,不明原因发热2例,症状分布差异有统计学意义(χ^(2)=58.467,P<0.001)。静脉血结核感染T细胞斑点检测(T-SPOT.TB)的阳性率高于结核分枝杆菌素试验(PPD试验)阳性率(P<0.001)。与置管前比较,置管后尿沉渣抗酸染色转阳6例、结核分枝杆菌培养转阳8例、结核分枝杆菌脱氧核糖核酸实时荧光定量聚合酶链反应(TB-DNA FQ-PCR)转阳25例、利福平耐药实时荧光定量核酸扩增技术(GeneXpert MTB/RIF)转阳23例,检测阳性率均升高,差异有统计学意义(P<0.05)。置管前后GeneXpert MTB/RIF阳性率均高于TB-DNA FQ-PCR、结核分枝杆菌培养及抗酸染色阳性率(P<0.001)。置管后肾盂分离度减轻(P<0.001),肾小球滤过率(GFR)升高(P<0.001),但中重度肾积水患者GFR无明显差异(P=0.136)。以结核分枝杆菌药敏试验为金标准检测利福平耐药性,GeneXpert MTB/RIF与结核分枝杆菌药敏试验具有高度的一致性(Kappa=1.000)。HRZE(H:异烟肼,R:利福平,Z:吡嗪酰胺,E:乙胺丁醇)规律抗结核治疗60.5(35.0,95.0)d后尿结核分枝杆菌检测转阴。结论不典型肾结核发病更加隐匿,T-SPOT.TB与GeneXpert MTB/RIF分别在不典型肾结核的筛查和病原学诊断中有较高的灵敏度,GeneXpert MTB/RIF的利福平耐药性检测敏感、可靠。HRZE可作为不典型肾结核的化疗方案,及早留置输尿管支架管可引流肾积水,保护肾功能,提高不典型肾结核的检出率,改善预后。Objective To explore the experiences in the diagnosis and treatment of atypical renal tuberculosis.Methods The medical records of 56 patients with atypical renal tuberculosis diagnosed and treated by the urologic surgery department of this hospital from November 2015 to February 2022 were analyzed.Results The reasons for the first seeing a doctor were different degrees of hydronephrosis or multiple cystic lesions of the kidney in 32 cases, mild frequent urination and urinary pain in 19 cases, lumbar and abdominal acid swelling discomfort on the affected side in 3 cases and unexplained fever in 2 cases, and the symptoms distribution had statistical difference(χ^(2)=58.467,P<0.001).The positive rate of venous blood T cell spot detection in tuberculosis infection(T-SPOT.TB) was higher than that of PPD(P<0.001).Compared with before catheterization, the positive conversion rate of acid fast staining of urine sediment after catheterization was in 6 cases, the positive conversion rate of Mycobacterium tuberculosis culture was in 8 cases, the positive conversion rate of TB-DNA FQ-PCR in 25 cases, the positive conversion rate of GeneXpert MTB/RIF was in 23 cases, the detection positive rates were increased, and the differences were statistically significant(P<0.05).The positive rate of GeneXpert MTB/RIF before and after catheterization was higher than that of TB-DNA FQ-PCR,Mycobacterium tuberculosis culture and acid fast staining(P<0.001).The degree of renal pelvis separation was reduced after catheterization(P<0.001),the glomerular filtration rate(GFR) was increased(P<0.001),but GFR in the patients with moderate and severe hydronephrosis had no significant difference(P=0.136).The drug sensitivity test of Mycobacterium tuberculosis was used as the gold standard to detect the rifampicin resistance, and GeneXpert MTB/RIF was highly consistent with the drug sensitivity test of Mycobacterium tuberculosis(Kappa=1.000).After the HRZE(H:isoniazid, R:rifampicin, Z:pyrazinamide, E:ethambutol) regular antituberculosis treatment fo

关 键 词：不典型肾结核 利福平耐药实时荧光定量核酸扩增技术 结核感染T细胞斑点检测 结核分枝杆菌培养 输尿管支架 

分 类 号：R692.9[医药卫生—泌尿科学]