慢性肾功能衰竭患者结核感染预防治疗的指征探讨

Indications of chemoprophylaxis for tubcrculosis in patients with chronic renal failure

观察了８３０例慢性肾功能衰竭患者长期随访过程中结核感染的发生情况，以探讨这类患者预防性抗结核治疗的指征。结果表明，既往有来经适当治疗的结核史或活动性结核接触史的患者，结核发生率（３３．３％），明显高于无上述病史者（４，５％，Ｐ＜０．０５）；胸部Ｘ线检查有钙化、硬结灶，胸膜增厚或肺门部阴影者，日后活动性结核的发生率（２７．３％）６倍于胸片正常者（４．４％，Ｐ＜０．０１）；血清抗结核菌纯蛋白衍生ＩｇＧ型抗体（抗ＰＰＤ－ＩｇＧ）阳性的患者４７．４％在病程中出现结核症状，与阴性者的结核发生率（２．３％）相比差异非常显著（Ｐ＜０．０１）。相反，结核菌素皮试阳性或阴性，有或无低蛋白血症，有或无糖尿病及结缔组织病以及老年和非老年患者之间，结核的发生率无明显差异。由此提示，具有前三项中一项或一项以上因素的慢性肾衰患者应视为结核感染的高危人群而给予预防性抗结核治疗。

The indications of chemoprophylaxis for tuberculosis(TB) in patients with chronic renal failure(CRF) were approached in this study. Mycobacterial infections occurred in 39 out of 830(4.7%)CRF patients,58. 9%(23/39) of them had TB symptoms within 12 months after hemodialysis(HD)or transplantation. Patients with personal history of TB or recent contact with active TB patients had a higher incidence of TB there after than those without such a history (33.3%Vs 4.5%,P<0.05). Ac-tive TB occured in 27.3%of patients with abnormal chest radiography on admision (i.e. calcification,pleural thickening and hilar prominence),the incidence was 6 times as high as that in patients with neg-ative chest radiograph.47.4%of patients with positive serum anti-PPD-IgG developed TB after HD or transplantation, but only 2.3%of those with negative serum anti-PPD-lgG did (P<0.01).The differ-ence in TB incidence between patients with positive and negative tubcrculin skin test was not statistical-ly significant.We therefore suggest that prophylaxis for TB should be given to patients with one or more of the following:1.History of TB or contact with active TB patients;2. Abnormal chest radiography;3.Positive serum anti-PPD-IgG.