贵州省维持性血液透析患者合并活动性结核感染的初步研究  

Preliminary study of active tuberculosis infections in maintenance hemodialysis patients

作　　者：李鹏 周贤位[2] 杨秀章 张明玲 杨水秀 Li Peng;Zhou Xianwei;Yang Xiuzhang;Zhang Mingling;Yang Shuixiu(Guiyang Public Health Clinical Center,Guiyang 550004,Guizhou,China;Department of Laboratory Medicine,the First People's Hospital of Guiyang City,Guiyang 550002,Guizhou,China)

机构地区：[1]贵阳市公共卫生救治中心,贵州贵阳550004 [2]贵阳市第一人民医院检验科,贵州贵阳550002

出　　处：《贵州医药》2025年第1期12-16,共5页Guizhou Medical Journal

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2021-081)。

摘　　要：目的了解贵州省维持性血液透析(MHD)并活动性结核感染患者的临床特征及分布情况,为血液透析患者结核防控提供临床依据。方法采用回顾性研究方法,选取2018年1月至2021年12月贵州省各地就诊于贵阳市公共卫生救治中心的MHD并活动性结核感染患者,按诊断活动性结核感染时既往是否行维持性血液透析进行分组:维持性血液透析结核(MHD TB)感染组和维持性血液透析前结核(Pre-MHD TB)感染组,收集临床资料并对其统计分析。结果纳入MHD患者121例,MHD TB感染组60例、Pre-MHD TB感染组61例,主要分布于贵阳市及毕节地区;两组均以继发性肺结核常见(83.60%VS.90.00%),肺外结核伴浆膜腔结核为主(31.10%VS.26.70%),但组间比较均无差异(P>0.05);同时结核感染两个部位以上者47例(38.80%)。Pre-MHD TB感染组以乏力、纳差为首发症状比例高于MHD TB感染组(23.00%VS.6.70%,P<0.05),且其肺外结核以泌尿系结核多见(P<0.05);MHD TB感染组以胸部CT检查异常为首诊的患者15例(25.00%),尤其以MHD合并糖尿病患者显著(P<0.05)。结论糖尿病MHD及Pre-MHD TB感染患者临床表现均无特异性,故需实行个体化监测,加强筛查力度及诊断效率,降低MHD并活动性结核感染患者结核暴露和院内交叉感染风险。Objective To investigate the clinical characteristics and distribution of patients with active tuberculosis infection undergoing maintenance hemodialysis(MHD)in Guizhou Province,and provide clinical evidence for tuberculosis prevention and control in hemodialysis patients.Methods A retrospective study was conducted using patients with MHD of active tuberculosis infection who were treated at the Guiyang Public Health Treatment Center from January 2018 to December 2021.Patients were grouped according to whether they had undergone maintenance hemodialysis before diagnosis of active tuberculosis infection that the MHD TB infection group and the Pre-MHD TB infection group.Clinical data were collected and statistically analyzed.Result A total of 121 patients with MHD were selected,including 60 patients in the MHD TB infection group and 61 patients in the Pre-MHD TB infection group,mainly distributed in Guiyang City and Bijie region.Both groups were commonly affected by secondary pulmonary tuberculosis(83.60%VS.90.00%),with extrapulmonary tuberculosis accompanied by serous cavity tuberculosis(31.10%VS.26.70%).However,there were no statistically significant differences between the two groups(P>0.05).At the same time,47 patients(38.80%)had more than two sites of tuberculosis infection.The Pre-MHD TB infection group had a higher proportion of patients with fatigue and poor appetite as the initial symptoms compared to the MHD TB infection group(23.00%VS.6.70%,P<0.05),and more cases of extra-pulmonary tuberculosis occur in the urinary system.There were statistically significant differences between groups(P<0.05).In the MHD TB infection group,15 patients(25.00%)were first diagnosed with abnormal chest CT examination,especially MHD patients with diabetes,and the comparison between the two groups was statistically significant(P<0.05).Conclusion The clinical symptoms of patients with diabetic MHD and Pre-MHD TB infection lack specificity,so individualized monitoring,strengthen screening and improved diagnostic efficiency are nee

关 键 词：血液透析 慢性肾脏病5期 结核感染 结核防控 

分 类 号：R52[医药卫生—内科学]