肾移植受者肺外结核的发病及诊治特点分析

目的 探讨肾移植患者术后肺外结核的发病及诊治特点. 方法 1991年1月至2007年4月行肾移植手术2333例,术后发现结核病37例,经病理学和(或)影像学检查确诊肺外结核者19例(51%).其中累及移植肾5例、脑膜4例、胸膜4例、淋巴结3例、软组织2例,喉、肝、胸椎、肠道各1例,同时有2个肺外部位受累者3例.发病高峰期为术后1年(53%).治疗方案主要采用异烟肼、利福平、乙胺丁醇和吡嗪酰胺组合,疗程6～25个月. 结果 14例经抗结核治疗痊愈,随访1～161个月,患者均存活且无复发;5例患者治疗无效,继发多脏器功能衰竭死亡(26%).抗结核治疗中发生急性排斥反应8例(42%),肝功能损害4例(21%). 结论肾移植患者术后肺外结核发生率、病死率较高,应引起临床足够重视,使用抗结核药物时应注意兼顾抗结核与抗排斥反应2方面.

Diagnosis and management of extra-pulmonary tuberculosis in renal transplant recipients

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients,and discuss its diagnosis and management. Methods From Jan.1991 to Apr.2007,37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center.Among them there were 19 cases with extra-pulmonary foci(51%),which involved allograft kidney in 5 cases,meninges in 4 cases,pleura in 4 cases,lymph node in 3 cases,soft issue in 2 cases,larynx,liver,vertebra and intestine in 1 case each.In 3 cases,there were 2 extrapulmonary sites involved at the same time.Most of the cases happened within one year post-transplant (53%).The most common clinical manifestation was fever. Results After anti-tuberculosis therapy,14 cases were cured and 5 were irresponsible and died.Eight cases (42%) experienced acute rejection and 4 cases(21%)had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population.Therefore,attention should be given to its differential diagnosis in clinical practice.Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population.