肾移植术后结核病18例回顾性临床分析

目的提高对肾移植术后合并结核病的认识。方法对近5年来肾移植术后结核病18例进行回顾性分析。结果肺结核16例,合并肺外结核3例,气管内膜结核2例,症状缺乏特异性。主要通过X线平片、反复痰中找抗酸杆菌、PCR查结核杆菌DNA、穿刺活检明确诊断。有4人合并其他病原体感染。经过正规抗结核治疗后治愈16人,死亡2人。不良反应主要是肝、肾功能损害,通过调整免疫抑制剂方案,肝、肾功能可恢复正常。结论肾移植术后结核感染发生率明显增高,正规抗结核治疗有效,但需要密切监测肝、肾功能的变化,及时调整免疫抑制剂方案。

Clinical analysis of tuberculosis infection in renal transplant patients

Objective To determine the possibility of illness with tuberculosis after receiving renal transplantion.Methods Retrospective analyze 18tuberculosis patients receiving after occured renal transplantation in recent 5 years.Results 16 cases were pulmonary tuberculosis cases and 3 of them combied with extrapulmonary tuberculosis and 2 combied with endobronchial tuberculosis.They were unequivocally diagnosed as tuberculosis by radiological plain film,searching acidfast becilli in sputum repeatedly,detecting DNA of Bacillus tuberculosis by PCR and biopsy,4 of whom had mixed infection in lung.16 patients recovered after standard antituberculosis therapy,but 2 died.Hepatic function lesion was main adverse reaction in treatment,but it could get normal after adjustment of immunodepressant.Conclusion Tuberculosis incidence rate in renal transplant patients increased obviously.Standard antituberculosis therapy is effective,but immunodepressant should be adjusted in time according to the change of hepatic function and renal function.