器官移植术后并发结核病临床分析

目的：分析并探讨器官移植术后并发结核病的临床特征、诊断及治疗。方法：回顾性分析我院接受器官移植术后结核病患者的临床资料。结果：30例器官移植术后并发结核病患者中肾移植患者25例,肝移植患者3例,肝肾联合移植患者1例,骨髓移植患者1例;临床症状主要表现为发热、盗汗、午后低热;其中出现胸水2例,腰痛及下肢无力3例;以肺结核感染多见,肺外结核6例;经抗结核治疗后痊愈21例,死亡1例。结论：器官移植术后并发结核病的临床表现不典型,应加强结核杆菌感染的检查,在治疗器官移植术后并发结核病患者时,应当注重合理选择抗结核药物,以保护患者肝肾功能为重点,妥善处理结核病,降低患者死亡率。     

器官移植术后并发结核病临床分析

目的:分析并探讨器官移植术后并发结核病的临床特征、诊断及治疗。方法:回顾性分析我院接受器官移植术后结核病患者的临床资料。结果:30例器官移植术后并发结核病患者中肾移植患者25例,肝移植患者3例,肝肾联合移植患者1例,骨髓移植患者1例;临床症状主要表现为发热、盗汗、午后低热;其中出现胸水2例,腰痛及下肢无力3例;以肺结核感染多见,肺外结核6例;经抗结核治疗后痊愈21例,死亡1例。结论:器官移植术后并发结核病的临床表现不典型,应加强结核杆菌感染的检查,在治疗器官移植术后并发结核病患者时,应当注重合理选择抗结核药物,以保护患者肝肾功能为重点,妥善处理结核病,降低患者死亡率。     

维持性血液透析患者并发结核菌感染的特点及处理

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.     

肝移植受者感染结核的诊治探讨

目的 探讨肝移植受者感染结核的诊断与治疗方法.方法 回顾性分析北京佑安医院肝移植术后并发结核的6例受者的临床资料.结果 肝移植受者术后结核感染发生率为1.62%（6/370）,结核感染发生距肝移植手术3～20个月,中位时间11.5个月.其中肺结核4例,骨结核1例,颅内结核1例.肺结核及骨结核病例经影像学检查后确诊,颅内结核应用诊断性治疗后确诊.6例患者抗结核治疗过程中,发生药物性肝损害1例,加用保肝药物后治愈;发生急性排斥反应2例,增加免疫抑制剂用量后急性排斥反应控制.6例结核最终均痊愈.结论 肝移植术后感染结核的临床表现多不典型,早期不易明确诊断,对出现不明原因发热、盗汗、体重下降等症状的患者需要高度警惕结核感染.肺结核及骨结核可通过影像学检查明确诊断,颅内结核诊断极为困难,诊断性抗结核治疗可能是明确诊断、抢救患者生命的惟一可行措施.及时抗结核治疗后患者多可治愈.     

肾移植术后并发肺外结核感染的诊断及治疗(附5例报告)

目的探讨肾移植术后合并发生肺外结核感染的诊断以及治疗并总结临床经验。方法回顾分析5例肾移植术后合并肺外结核感染患者的临床资料。结果 2005年1月至2010年12月收治的肾移植术后结核病患者有5例为肺外结核,其中3例顺利完成疗程并临床治愈;1例在治疗过程中因病情严重死亡;1例尚在治疗中但病情已显示出有明显好转。结论肺外结核感染严重威胁肾移植患者的长期存活。肾移植受者肺外结核感染临床表现不典型,早期诊断及规范治疗能提高肾移植感染患者治愈率。     

体表软组织结核23例诊治分析

探讨体表软组织结核的诊断和治疗.方法:对2004年10月至2010年12月诊治的23例体表软组织结核感染患者进行总结分析.结果:本组病例全部治愈.部分病例早期诊断不清,延误诊治.结论:对软组织感染创面观察分析,迁延不愈10d以上者,要考虑结核感染的可能,可行诊断预防性抗结核治疗.必要时切取病变组织进行病检,确诊为结核感染患者行正规抗结核治疗.抗结核治疗要监测肝功能及药物副反应.     

三种检测方法在肺外结核病诊断中价值的探讨

目的探讨结核分枝杆菌DNA检测、血清结核抗体检测及结核菌素试验3种方法在肺外结核诊断中的价值。方法采用病例对照研究方法,将所观察对象分为两组,非结核病组121例及肺外结核病组132例,各组诊断采用双盲法,且有可比性。对非结核病组的血标本或痰标本及肺外结核组血标本或/和结核性胸膜炎的胸水标本、结核性腹膜炎的腹水标本、结核性脑膜炎的脑脊液标本和泌尿系结核的尿液标本、部分颈淋巴结结核干酪坏死分泌物标本进行PCR扩增及ABI-7 300仪器荧光检测结核分枝杆菌DNA定量。应用统计学分析敏感性、特异性。对所选病例均同时做血清抗结核抗体检测及结核菌素试验。结果结核杆菌DNA检测肺外结核病的敏感性34.85%、特异性85.12%;血清抗结核抗体敏感性62.88%、特异性52.07%;结核菌素试验敏感性65.15%、特异性65.15%。结论结核分枝杆菌DNA分子生物学检测技术快速准确、特异性高、假阴性低、需时短,缩短了肺外结核诊断的检测时间,为早期诊断、早期治疗提供有效支持。血清结核抗体检测及结核菌素试验的敏感性和特异性均较高,阳性结果提示感染结核分枝杆菌。3种方法是诊断肺外结核病必要的辅助方法。     

慢性肾脏病合并结核感染诊治进展

慢性肾脏病（Chronic kidney disease ,CKD）和结核病是危及人类健康的慢性疾病,慢性肾脏病患者感染结核的风险增加,与CKD的进展有关,且肺外结核发生率高,临床症状不典型,结核相关筛查实验阳性率低,CKD患者抗结核药物副作用较普通人群高且严重,预后更差,早期诊断及及时治疗对改善预后有重要意义。     

3例终末期肾病患者合并结核感染的病例报道及文献复习

目的通过3例终末期肾病(end-stage renal disease,ESRD)患者合并结核杆菌感染的病例,探讨ESRD患者结核杆菌感染的不典型性、诊治线索以及治疗时机。方法回顾性分析首都医科大学康复医学院3例ESRD患者合并结核感染病例的临床表现、诊治思路、治疗结局,并进行相关文献复习。结果 1例患者因高龄、合并症多、确诊时间晚,最终死亡;1例经试验性抗结核治疗后症状好转,病情平稳;1例患者高度疑诊结核性腹膜炎,抗生素腹腔用药5天无效,拔除腹膜透析管后转为血液透析,同时抗结核治疗1年,病情平稳。结论 ESRD患者并发结核杆菌感染,临床症状多不典型且以肺外结核多见,如怀疑合并结核杆菌感染,可在密切观察相关药物副作用的前提下,尽早行试验性抗结核治疗,以免延误诊断和治疗时机,导致不良预后。     

骨与关节结核590例治疗体会

目的探讨骨与关节结核的药物治疗及外科手术治疗。方法对590例骨与关节结核病人中110例初期单纯关节滑膜结核、婴幼儿、老年体弱合并其他主要脏器病症、肝肾功能有严重损害的脊柱结核病例行药物治疗外，其余480例病人在药物治疗的同时行外科手术治疗。结果经随访死亡4例脊柱结核外其余药物治疗病例症状，体征不同程度改善，手术病例均恢复正常工作及生活。结论骨关节结核的治疗需严密检测并保护肝肾功能的前提下定最佳的用药方案，严格掌握手术适应证、手术时机、手术方法才能达到满意效果。     

Extrapulmonary tuberculosis: an overview

In the 1980s, after a steady decline during preceding decades, there was a resurgence in the rate of tuberculosis in the United States that coincided with the acquired immunodeficiency syndrome epidemic. Disease patterns since have changed, with a higher incidence of disseminated and extrapulmonary disease now found. Extrapulmonary sites of infection commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. The diagnosis of extrapulmonary tuberculosis can be elusive, necessitating a high index of suspicion. Physicians should obtain a thorough history focusing on risk behaviors for human immunodeficiency virus (HIV) infection and tuberculosis. Antituberculous therapy can minimize morbidity and mortality but may need to be initiated empirically. A negative smear for acid-fast bacillus, a lack of granulomas on histopathology, and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis. Novel diagnostic modalities such as adenosine deaminase levels and polymerase chain reaction can be useful in certain forms of extrapulmonary tuberculosis. In general, the same regimens are used to treat pulmonary and extrapulmonary tuberculosis, and responses to antituberculous therapy are similar in patients with HIV infection and in those without. Treatment duration may need to be extended for central nervous system and skeletal tuberculosis, depending on drug resistance, and in patients who have a delayed or incomplete response. Adjunctive corticosteroids may be beneficial in patients with tuberculous meningitis, tuberculous pericarditis, or miliary tuberculosis with refractory hypoxemia.     

Clinical characteristics of miliary tuberculosis today

Present-day miliary tuberculosis (MT) is characterized clinically. Changes in its classical presentation are found, i.e. in acuteness, sudden onset, intoxication. Generalized process with pulmonary and extrapulmonary miliary foci is accompanied with monopenia indicating profound disorders of phagocytic immunity in miliary tuberculosis.     

γ-干扰素释放试验对肺结核与肺外结核诊断的敏感性和特异性观察

目的 探讨肺结核与肺外结核γ-干扰素释放试验(IGRAs)在肺结核和肺外结核诊断中的应用价值。方法 选择该院2014年7月至2015年7月住院结核病疑似病例217例,常规进行相关检测及IGRAs试验,所有患者随访3个月,根据结核诊断依据分为2组,结核确诊和临床诊断组81例,无结核证据组136例,观察IGRAs试验结果。结果IGRAs试验敏感度为93.83%(76/81),其中肺结核和肺外结核的敏感度分别为95.74%、91.17%,敏感度比较差异无统计学意义(P0.05)。特异度为84.56%(115/136)。其中肺结核和肺外结核的特异度分别为80.00%、91.07%,肺外结核的特异度明显高于肺结核,差异具有统计学意义(P0.05)。5个单位皮肤试验敏感度和特异度分别为56.79%、62.50%。IGRAs试验敏感度、特异度、阳性预测值、阴性预测值均高于TST皮肤试验,差异具有统计学意义(P0.05)。结论 IGRAs试验在肺结核与肺外结核中有较高敏感度和特异度,特别是在排除结核的诊断上具有较高的临床价值。     

类风湿关节炎合并活动性肺结核病的临床特征及相关因素分析

目的 分析类风湿关节炎(RA)合并活动性肺结核病的临床特征以及相关危险因素.方法 回顾分析41例RA合并活动性肺结核住院患者临床资料,按照年龄、性别1:1匹配选择同期无RA及其他风湿疾病的活动性肺结核住院患者进行临床特征分析,随机选取101例无活动性肺结核及其他病原体感染的RA同期住院患者进行相关因素分析,所有患者均有...     

LCx Mycobacterium tuberculosis assay is valuable with respiratory specimens, but provides little help in the diagnosis of extrapulmonary tuberculosis

BACKGROUND: Commercial nucleic acid amplification tests, designed for the detection of Mycobacterium tuberculosis DNA/RNA in respiratory samples, are often applied also in nonrespiratory specimens in order to verify the diagnosis of extrapulmonary tuberculosis. AIM. To evaluate the value of the Abbott LCx Mycobacterium tuberculosis assay for the diagnosis of pulmonary and extrapulmonary tuberculosis based on routine clinical laboratory results. METHODS: The assay was used to analyse 350 respiratory and 826 nonrespiratory specimens from 961 patients, of whom 3.6% had culture-proven tuberculosis. The results obtained by the LCx assay were compared with the records on mycobacterial isolates of the national reference laboratory and, in the case of positive findings, with clinical data. RESULTS: In comparison with culture, the sensitivity, specificity and positive/negative predictive value of the assay on respiratory specimens were 87.5%, 99.7%, 93.3% and 99.4%, respectively. With nonrespiratory specimens, the overall sensitivity, specificity and positive/negative predictive value of the LCx assay were 73.3%, 98.0%, 40.7% and 99.5%, respectively. When clinical and histological data were also included, the positive predictive value of LCx with nonrespiratory specimens was 45.8%. CONCLUSION: Critical interpretation of the nucleic acid amplification results obtained from nonrespiratory specimens is necessary in both laboratory and clinical settings.     

三种检测方法在结核病中的诊断价值比较

目的 比较3种检测方法在不同类型结核病中的诊断价值.方法 选取2020年1-12月于该院住院的患者140例为研究对象,其中结核病组111例(肺结核组103例和肺外结核组8例),非结核病组29例.同时采用外周全血γ-干扰素释放试验(IGRA)、结核分枝杆菌培养、实时荧光定量核酸扩增检测(Xpert MTB/RIF)3种方...     

Treatment of tuberculosis

The incidence of tuberculosis is increasing in the United States. Although the lung is still the most common site of infection, extrapulmonary disease is becoming more prevalent, particularly in patients infected with human immunodeficiency virus (HIV). Clinically active tuberculosis is treated with a combination of drugs. Recommended therapy consists of a six-month regimen of isoniazid and rifampin, with pyrazinamide given for the first two months. Longer regimens are used in patients infected with HIV. Monthly monitoring for adverse effects and treatment response is necessary. Compliance is the most important factor for successful treatment. Treatment failure usually requires the use of more toxic second-line drugs. In such cases, drug susceptibility studies may be useful.     

Miliary tuberculosis: unusual cause of abdominal pain in pregnancy.

We have described a case of miliary tuberculosis, with symptoms primarily due to hepatic involvement during pregnancy. Liver biopsy showed granulomatous hepatitis, and subsequent cultures of sputum, urine, and gastric aspirate were positive for Mycobacterium tuberculosis. Although this patient was seronegative for HIV, an increased incidence of extrapulmonary and disseminated tuberculous infection has recently been noted in patients with HIV infection. Given the increasing incidence of HIV in the general population, we may therefore anticipate a corresponding rise in the incidence of extrapulmonary tuberculosis. Since an increasing number of gravidas will be immunocompromised by HIV infection, renewal of knowledge regarding diagnosis of miliary tuberculosis in pregnancy is valuable.     

Various approaches to tuberculosis diagnosis in patients with hemoblastosis

AIM: To characterize diagnosis of tuberculosis in hemoblastosis patients. MATERIAL AND METHODS: Diagnosis of active tuberculosis in 2.6% from 2123 hemoblastosis patients admitted to Hematological Research Center in 1990-1999 shows that such patients can be referred to high risk group in relation to tuberculosis infection. Methods and terms of tuberculosis diagnosis in hemoblastosis patients are analysed. RESULTS: Bacteriological and histological tests were positive in 27.8% examinees with hemoblastosis. In extrapulmonary tuberculosis location, histological diagnosis was positive in 60%. Especially helpful is a complex of clinical and x-ray examinations in high tuberculosis alertness. This allowed to suspect the infection in 51.9% patients (63.9% had pulmonary location). A marked positive response to antituberculosis treatment proved tuberculosis diagnosis. CONCLUSION: Difficulties of tuberculosis diagnosis in hemoblastosis patients are explained by low informative effectiveness of most common methods of this infection verification. Therefore, in addition to bacteriological and histological examinations, clinical diagnostic techniques should be employed keeping alert in relation of tuberculosis in hemoblastosis patients who are at risk to catch this infection.