›› 2007, Vol. 6 ›› Issue (8): 425-427.

• 论著 • 上一篇    下一篇

维持性血液透析患者并发结核菌感染的特点及处理

蔡美顺 王 梅 甘良英 王 宓 王 磊 谈一意 张大伟

  

  1. 100044 北京,北京大学人民医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-08-12 发布日期:2007-08-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-08-12 Published:2007-08-12

摘要: 目的 分析维持性血液透析患者并发结核菌感染的临床特点。方法 2006年1~12月在北京大学人民医院血液透析中心维持性血液透析患者有116例,其中并发结核菌感染的患者共4例,收集其临床资料、实验室检查及影像学检查资料,分析患者的临床表现、诊断及治疗与转归的情况。结果 4例(3.45%)维持性血液透析合并结核菌感染的患者中有1例感染部位不明的肺外结核、1例淋巴结结核、结核性胸膜炎及腹膜炎各1例。最常见的症状是经一般抗生素治疗无效的发热,结核中毒症状均不明显。在除外肿瘤、一般微生物感染的情况下,给予抗结核试验治疗后4例患者在2~8周内症状明显减轻,经6~9个月抗痨治疗后淋巴结肿大、胸腔积液、腹腔积液等症状均缓解。结论 维持性血液透析患者并发结核菌感染的症状多不典型且以肺外结核多见,如怀疑合并结核菌感染可尽早行抗结核试验性治疗。

关键词: 血液透析, 结核, 转归

Abstract: Objective To investigate clinical features, treatment and outcome of tuberculosis complicated in maintenance hemodialysis patients. Methods During the period from January to December in 2006, 4 tuberculosis cases were found in the 116 maintenance hemodialysis patients in our hemodialysis center. Their clinical, laboratory and medical imaging data were collected and their clinical features, diagnosis, treatment and outcome were retrospectively analyzed. Results The 4 cases (3.45%) had extra-pulmonary tuberculosis of unknown origin, lymph node tuberculosis, tuberculous pleural effusion and tuberculous peritoneal effusion, respectively. The predominant feature was fever without other toxic symptoms and without responses to the commonly used antibiotics. An empirical trial of anti-tuberculosis medication was given after tumors and other bacterial infections were excluded. Two to eight weeks after the treatment, the symptoms relieved obviously. Fever, enlarged lymph node, pleural effusion and peritoneal effusion disappeared after the treatment for 6-9 months. Conclusion The symptoms of tuberculosis infection are usually atypical in maintenance hemodialysis patients. Extra-pulmonary tuberculosis is frequently encountered. If the diagnosis of tuberculosis can not be excluded clinically, an empirical trial of anti-tuberculosis medication should be prescribed.

Key words: Tuberculosis, Outcome

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