肾脏移植术后结核感染

目的:探讨肾脏移植术后结核感染的临床特点、诊断及治疗经验。方法:回顾性分析7例肾脏移植术后结核感染患者的临床资料:结果:肾脏移植术后结核感染率为3.2％(7/217),其中肺结核5例,结核性脑膜脑炎1例,移植肾结核1例。诊断主要依靠临床资料,X线照片,痰液抗酸染色,PER查结核杆菌。治疗以雷米封 吡螓酰胺为主,酌情减少免疫抑制剂用量。本组治愈5例,好转1例,死亡1例:不良反应主要是肝功能异常,移植肾无急性排斥反应发生,移植肾功能保持正常:结论:肾脏移檀术后结核感染的发生率显著高于正常人群。对于肾脏移植术后不明原因的发热或常规抗感染无效,即使无实验检查支持,也应高度怀疑结核感染,并尽早进行抗结核治疗。治疗过程中容易发生肝功能损害。

Tuberculosis infections after kidney transplantation

Objective To explore diagnosis and treatment of tuberculosis infection following kidney transplantation.Methods A retrospective analysis was made on 7 tuberculosis infection patients after kidney transplantation.Re-sultsThe proportion of tuberculosis infection was 3.2%(7/217) in kidney transplantation. The location of tuberculosis infections was the lungs ( 5 cases ), meninx ( 1 case ) and Allo-kidney (1 case ). The diagnosis of patients was based on the clinical information, chest X-ray examination, smears for acid-fast bacilli of a fresh sputum, PCR for tuberculosis bacilli DNA. Rimifon Pyrazinamide was chiefly plan of therapy, immunosuppressant was decreased reasonably. The results showed that 5 were cured, one was seen making progress, one died. Abnormal liver function was chiefly side effect. Function of renal transplantation was normal. Acute rejection did not occurred in 7 patients. Conclusion Because of the immunosuppressant use and cellular immune hopofunction, the incidence of tuberculosis infection after kidney transplantation is higher than that of the normal. The patients with high fever after kidney transplantation who had no efficiency to antibiotic should be suspected tuberculosis infection even in the absence of any laboratory evidence. Antituberculosis therapy should be started as early as possible whenever suggestive clinical finding of tuberculosis infection are present. The liver function is easily impaired in the therapeutic course.