慢性肾功能衰竭接受替代治疗病人并发结核病

TUBERCULOSIS IN CHRONIC RENAL FAILURE PATIENTS WITH OR WITHOUT RENAL RE-PLACEMENT THERAPY

为了解慢性肾功能衰竭治疗中并发结核情况，对我院近５年收治的９７８例慢性肾功能衰竭接受替代治疗的病人进行了分析，其中４０例并发结核病，发生率为４．１％，为一般人群的１０倍。结核病６８％发生于透析或肾移植术后１年之内。其中肺外结核占８２．５％，淋巴结核是最常见的表现类型。慢性肾功能衰竭并发结核病的诊断仍有一定困难，结核菌素皮试在这类病人的阳性率仅６．４％。检测血清抗结核菌纯蛋白衍生物抗体（ＰＰＤ－ＩｇＧ）是一个有价值的辅助诊断方法，本组活动性结核８５％（３４／４０）呈阳性反应。并发浆膜腔或泌尿系结核的病人，检测渗出液或尿的抗ＰＰＤ－ＩｇＧ，或以聚合酶链反应（ＰＣＲ）检测结核菌ＤＮＡ有助于诊断。

uberculosis developed in 40 out of 978 chronic renal failure(CRF)\ patients with or without renal re-placement therapy during a five-year period. The incidence was 4.1%and was 10 times higther than that inthe general population. The onset of symptoms was within 1 year after dialysis or kidney transplantation in68%of the patients.82.5%of them had predominantly extrapulmonary tuberculosis and most of thesewere lymph node infection. The diagnosis of tuberculosis in these patients was difficult;tuberculin sensitiv-ity was present only in 6.4%of the patients and examination of sputum and other fluid for mycobacteriawas usually unrewarding. Detecting serum anti-PPD-IgG level might be a valuable supplementary diagnos-tic method, because 85%of patients with active tuberculosis showed positive results. Measuring:erous ex-udate and urine anti-PPD-IgG level by ELISA or M. Tuberculosis DNA by PCR might be helpful in thediagnosis of tuberculous serositis and urinary tract mycobacterial infection.