1069例慢性肾衰患者合并结核病的临床对比研究

目的探讨慢性肾衰合并结核病的发病率及临床特点。方法统计该科1997~2001年住院慢性肾衰患者合并结核病的有关情况,与同期重庆市有关资料进行对比分析。结果1069例慢性肾衰患者中,合并结核病者49例,其发病率(4592/10万)显著高于我市同期结核病发病率(151/10万,P <0.001),其中半数以上是不典型肺外结核;随着肾衰程度的加重,合并结核的发生率逐渐升高;抗结核抗体和PPD阳性率(12.2%, 14.3%)显著低于普通结核患者(71.3%, 57.1%,P<0.05);2/3倍于常用剂量的抗痨治疗有效,8例抗痨1年以后接受肾移植者预后良好,而2例抗痨不足半年接受肾移植的患者术后症状复发,治疗无效死亡。结论慢性肾衰易合并结核,特别是不典型肺外结核,对于长期发热的慢性肾衰患者,应想到结核,在排除其他发热原因后,可考虑诊断性抗痨治疗,慢性肾衰合并结核患者抗痨治疗1年后肾移植是安全的。

Compared clinical analysis of chronic renal failure infected partially with tuberculosis in 1069 cases

Objective: To investigate the clinic characteristics of chronic renal failure(CRF) patients suffering from tuberculosis. Methods: The clinic materials of CRF inpatients suffering from tuberculosis from 1997 to 2001 were investigated and compared with these materials of Chongqing in same period. Results: In 1069 CRF inpatients, 49 suffered from tuberculosis, over half of whom were atypical type V tuberculosis (lesion spot was uncertain), and the incidence (4592/100,000) was significantly higher than that of Chongqing (151/100,000; P<0.001). The worse the renal function, the higher the tuberculosis incidence. The CRF patients suffering from tuberculosis had a lower positive incidence of anti-tuberculosis-antibody and PPD test (12.2%, 14.3%) than that of tuberculosis patients without CRF (71.3%,57.1%, P<0.05). The 2/3 dosage anti-tuberculosis drug treatment was effective. Eight cases had good outcome after kidney transplantation who had received 1 year anti-tuberculosis treatment. But other two patients died after kidney transplantation who received less than half a year anti tuberculosis treatment. Conclusion: CRF patients are susceptible to tuberculosis, especially to atypical tuberculosis outside lung. Anti-tuberculosis treatment might be necessary for CRF patients suffering from chronic fever after eliminating other causes. It is safe for the patients with CRF plus tuberculosis to receive kidney transplantation after one year of anti-tuberculosis treatment.