肾结核323例诊治探讨

Investigate of the Diagnosis and Treatment for Renal Tuberculosis

目的探讨肾结核的临床表现,争取做到早期诊断和治疗。方法回顾性分析323例肾结核患者的临床资料。结果临床表现膀胱刺激征229例(71%),腰痛伴肉眼血尿61例(19%),镜下血尿合并蛋白尿46例(14%)。尿查抗酸杆菌、聚合酶链反应结核菌(PCR-TB-DNA)和血清抗结核特异性抗体(PPD-IgG)检查阳性率分别为37.7%,47.1%和52.3%;IVU,B超,CT的诊断阳性率分别为69.1%,31.2%,86.3%.尿沉渣红细胞MCV测定值≥77fl,诊断符合率为98.3%.227例接受药物(INH+RFP+PZA,12个月)治疗,痊愈183例(81.1%);96例接受手术治疗,术后病理均诊断为肾结核。结论尿液检查、尿沉渣红细胞MCV测定联合影像学检查可以提高肾结核的早期诊断率,早期肾结核内科三联治疗效果满意。无功能肾结核行肾切除时应尽可能切除患侧输尿管。

Objective To investigate the clinical manifestions,diagnosis and treatment of renal tuberculosis（TB）. Methods A retrospective study was made on 323 patients of renal TB. Results Two hundred and twenty nine cases （71% ） presented with irritative symptoms. Sixty one cases （ 19% ） had lumbago accompanied by healnaturia. Folty six cases （ 14% ） had mierosopic hematuria aceompanied with proteinuria. The positive result of acid-fast stains,urinary TB-PCR,PPD-IgG were 37.7% ,47.1% ,52.3% .The diagnostic accuracy of urography,CT anti B-type ultrosonography were 69. 1%, 31.2 %, 86.3 %. Urinary RBC MCV ≥ 77fl, conformity rate was 98.3 %. 183 of 227 cases had been cured on medicine （INII ＋ RFP＋ PZA, for 12 monthes）. Ninety six cases undergoing surgery were pathologically diagnosed to have renal TB. Conclusions Combined use of urine examinalion, urinary RBC MCV and photo-technique can help to assess the diagnosis of renal TB. INH, RFP and PZA used combinedly achieves satisfactory outcome for early carses. When nephro-nreterectomy is indicated,the involved ureter should be excised as much as possible.