泌尿系统结核29例临床分析

目的总结泌尿系统结核的临床特点。方法回顾性分析1998年12月31日—2008年12月31日在中山大学附属第二医院住院的泌尿系统结核患者的临床资料。记录患者的一般情况、既往病史、临床表现、实验室检查、影像学检查及诊断和误诊情况。结果10年间共收集泌尿系统结核患者29例，肾脏受累者24例（占82．8％），输尿管受累者11例（占37．9％），膀胱受累者3例（占10．3％）。合并肺结核9例，泌尿系统以外的肺外结核5例，存在免疫功能受损者10例。常见临床特征包括膀胱刺激征18例（占62．1％），腰痛17例（占58．6％），白细胞尿14例（占48．3％）及血尿14例（占48．3％）。经病理学检查确诊22例，经病原学检查确诊5例，经诊断性治疗确诊2例。初次就诊至确诊的时间中位数为4个月（0～10年）。结论对于存在肺结核及其他部位肺外结核的成年患者，出现一般抗感染治疗无反应的慢性膀胱炎或无菌性脓尿时，应高度怀疑泌尿系统结核的可能。宜及早行静脉肾盂造影（IVP）或电子计算机断层扫描（CT）检查，反复尿沉渣涂片抗酸染色、结核菌培养、结核菌聚合酶链反应（PCR）检查有助于泌尿系统结核的早期诊断。

Clinical analysis of 29 cases of urinary tract tuberculosis

Objective To summarize the clinical characteristics of urinary tract tuberculosis. Method Clinical data of 29 cases of urinary tract tuberculosis admitted to the Second Affiliated Hospital of Sun Yat - Sen University from 31 December 1998 to 31 December 2008 were investigated retrospectively. The general conditions, past medical history, clinical manifestations, laboratory and imaging examinations, diagnosis and misdiagnosis were collected. Result Among the total cases, kidney was involved in 24 cases（82.8% ） ,urinary tract was involved in 11 cases（37.9% ） and bladder was involved in 3 cases （10.3）. 9 patients had pulmonary tuberculosis, 5 had extrapulmonary tuberculosis （not including urinary system）, and 10 had immune deficiency. The common clinical manifestations were bladder irritation （62.1%） ,backache（58.6% ） ,leukocyturia（48.3% ） and hematuria（48.3% ）. The diagnosis were confinned by histopathological examination in 22 cases , by etiological examination in 5 cases and by diagnostic treatment in 2 cases. The median duration from first visit to confirmed diagnose was 4 months （0 - 10 years）. Conclusion For adults with tuberculosis in lung and other sites, urinary tract tuberculosis should be highly suspected in the presence of chronic cystitis unresponsive or pyuria without bacteria to adequate antibiotic therapy. IVP or CT investigation should be taken at earlier period. At least three consecutive early morning specimens of urine for acid-fast stain, TB culture and Mycobacterium tuberculosis PCR are very helpful for early diagnosis.