肝移植术后肺结核患者的临床特点及诊疗分析  

Analysis on the clinical characteristics and process of diagnosis and treatment of patients with pulmonary tuberculosis after liver transplantation

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作  者:傅红梅[1] 俞朝贤[2] 李春燕[1] 谭毅刚[1] 岑滢[1] 李翠萍[1] 刘志辉[3] Fu Hongmei;Yu Zhaoxian;Li Chunyan;Tan Yigang;Cen Ying;Li Cuiping;Liu Zhihui(Department of Tuberculosis Internal Medicine,Guangzhou Chest Hospital,Guangzhou 510095,China;Department of Critical Care Medicine,Guangzhou Chest Hospital,Guangzhou 510095,China;Clinical Laboratory,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区:[1]广州市胸科医院结核内科,广州510095 [2]广州市胸科医院重症医学科,广州510095 [3]广州市胸科医院医学检验科,广州510095

出  处:《国际医药卫生导报》2024年第14期2366-2370,共5页International Medicine and Health Guidance News

基  金:国家重点研发计划“病原学与防疫技术体系研究”重点专项(2022YFC2304800);广东省医学科学技术研究项目(A2020556);广州市医学重点学科(2021-2023年)结核病学。

摘  要:目的探讨肝移植术后罹患肺结核患者的临床诊疗规律。方法收集广州市胸科医院2014年1月至2023年12月期间的住院患者资料,对照分析25例肝移植术后肺结核住院患者(研究组)和31例同期非器官移植肺结核住院患者(对照组)的临床症状、病灶累及部位、诊断时长、住院次数、每次住院时长以及临床治疗效果。其中,男55例、女1例,年龄1~75岁,平均年龄66岁。统计学方法应用χ^(2)检验、秩和检验。结果研究组的发热、疲乏消瘦率均高于对照组[68.0%(17/25)比22.6%(7/31)、56.0%(14/25)比29.0%(9/31)],差异均有统计学意义(χ^(2)=11.66、4.16,均P<0.05)。CT影像下结核病灶累及胸肺部位(包括肺叶、支气管和胸膜)及空洞病灶情况两组差异均无统计学意义,但肺外(下肢、腹腔、颈、脑、腰椎、睾丸等)结核发生率研究组高于对照组[44.0%(11/25)比3.2%(1/31)],差异有统计学意义(χ^(2)=13.67,P<0.05)。研究组患者结核病的发生时间在肝移植术后3~240个月(P_(25)、P_(50)、P_(75)分别为24、40、75个月),结核病诊断时长与每次住院时长两组间差异均无统计学意义(均P>0.05)。研究组患者4例因晚期肿瘤不治死亡、1例截至2023年12月尚未完成疗程但病情明显好转,其他20例患者在12~36个月(P_(25)、P_(50)、P_(75)分别为14、15、18个月)抗结核治疗后均已治愈;对照组患者1例因晚期肺癌死亡,其他30例在6~18个月(P_(25)、P_(50)、P_(75)分别为12、12、14个月)抗结核治疗后均已治愈;研究组治疗疗程长于对照组(Z=3.54,P<0.05)。研究组住院3次以上患者占20.00%(5/25),对照组占6.45%(2/31),研究组高于对照组(χ^(2)=42.83,P<0.05)。结论肝移植术后肺结核患者肺外结核发生率高、病情变化复杂、抗结核治疗疗程长,值得临床密切关注。Objective To explore the clinical principles of diagnosis and treatment for patients with pulmonary tuberculosis after liver transplantation.Methods The inpatients treated in Guangzhou Chest Hospital from January 2014 to December 2023 were collected,and the data or information related to the clinical symptoms,lesion location involved,duration of diagnosis,number of hospitalizations,length of hospital stay each time,and clinical therapeutic effect of 25 inpatients with pulmonary tuberculosis after liver transplantation(study group)and 31 inpatients with pulmonary tuberculosis but non-organ transplantation(control group)were comparatively analyzed.Among them,there were 55 males and 1 female,ranging in age from 1 to 75 years old,with an average age of 66 years old.χ^(2) test and rank sum test were used for statistical methods.Results The rates of fever and fatigue and emaciation in the study group were higher than those in the control group[68.0%(17/25)vs.22.6%(7/31),56.0%(14/25)vs.29.0%(9/31)],with statistically significant differences(χ^(2)=11.66 and 4.16,both P<0.05).There were no statistically significant differences between the two groups in the incidences of tuberculosis lesions in thorax and lung(including lung lobes,bronchus,and pleura)and cavity lesions under CT images,but the incidence of extra-pulmonary tuberculosis(lower extremities,abdominal cavity,neck,brain,lumbar vertebra,testis,etc.)in the study group was higher than that in the control group[44.0%(11/25)vs.3.2%(1/31)],with a statistically significant difference(χ^(2)=13.67,P<0.05).The onset time of tuberculosis in the study group ranged from 3 to 240 months after liver transplantation(P_(25),P_(50),and P_(75) were 24,40,and 75 months,respectively),and there was no statistically significant difference in the duration of tuberculosis diagnosis or length of hospital stay each time between the two groups(both P>0.05).In the study group,4 patients died due to advanced tumor,1 patient had not yet completed the course of treatment by December 2023,but

关 键 词:肝移植 肺结核 临床特征 

分 类 号:R521[医药卫生—内科学] R657.3[医药卫生—临床医学]

 

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