肾移植术后并发肺结核的早期诊治与预防

目的探讨肾移植术后并发肺结核感染的早期诊治与预防。方法2002年1月至2009年12月共行同种肾移植术1024例，术后发现合并肺结核的患者18例，发生率为1．76％。18例合并肺结核的患者中，男性10例，女性8例，平均年龄43．33岁；移植后均采用三联免疫抑制方案；有14例应用免疫诱导治疗，其中4例用抗CD25单克隆抗体，10例用抗胸腺细胞球蛋白或抗淋巴细胞球蛋白。结果。肾移植术后合并肺结核的发病时间为1～54个月，有12例患者是在术后12个月内发病。术后合并肺结核的早期临床表现不典型，发热是早期的主要症状，临床确诊主要靠使用肺部高分辨CT（HRCT）和支气管肺泡灌洗液（BALF）镜检。经过正规抗结核治疗后治愈17例，死亡1例。结论。肾移植术后肺结核感染早期临床表现不典型。HRCT是发病早期的重要检查手段，BALF镜检是确诊的主要依据。早期诊断和治疗是决定预后的关键。应加强对高危受者的监察力度及预防措施。

Early diagnosis,treatment and prevention of tuberculosis following kidney transplantation

Objective To establish early diagnosis, treatment and prevention of tuberculosis infection following kidney transplantation. Methods Eighteen post-operative tuberculosis infections were identified among 1024 kidney transplantations performed in Beijing Chaoyang Hospital between January 2002 and December 2009. Triple immunosuppressive therapy strategy was used for these 18 patients. Of the 14 patients who received immune induction therapy,4 were treated with monoclonal antibody, and the other 10 were treated with anti-thymocyte globulin （ATG） or anti-lymphocyte globulin （ALG）. Results The interval between renal transplantation and identification of tuberculosis infection ranged from 1 to 54 months. Post- transplant tuberculosis infection showed no typical clinical manifestations at early stage. Persistent or intermittent fever was the main symptom. High resolution CT and bronchoalveolar lavage fluid （BALF） test were useful tools for confirmed diagnosis. After routine anti-tuberculosis treatment, 17 patients were cured and 1 patient died. Conclusions The early stage symptoms of post-transplant tuberculosis may be atypical, which could result in misdiagnosis. Pulmonary high-resolution CT examination and BALF test could provide strong evidence for tuberculosis infection.