器官移植术后结核病25例临床分析并文献复习

Tuberculosis after organ transplantation:clinical analysis and literature review

目的探讨器官移植术后结核病的临床特征、诊断和治疗。方法分析总结了25例器官移植术后结核病的临床资料并进行了文献复习。结果 68%(17/25)的患者起病时症状轻微,主要表现为发热、咳嗽、乏力和胸闷,肺结核、胸膜炎、血行播散性结核、淋巴结核和肾结核较为常见,72%(18/25)的患者侵犯2个以上器官。影像学多为范围广泛的软性病灶、粟粒结节、胸腔积液、肺门纵隔淋巴结增大和空洞。细菌学和组织学检查有助于诊断。平均确诊时间为38 d,治疗总有效率为76%(19/25)。因极度免疫功能低下和肝肾功能损害,无法使用抗结核药物是影响器官移植术后结核病预后的重要因素。结论应对免疫抑制并发的结核病引起高度重视,正确诊断和及时处理是降低其死亡率的重要手段。

Objective To describe the clinical features, diagnosis and treatment of tuberculosis after organ transplantation. Method The clinical data of 25 cases of tuberculosis after organ transplantation were retrospectively analyzed. Results Sixty-eight percent of the patients presented only mild symptoms. Fever, cough, malaise and chest tightness were among the most common manifestations. Pulmonary tuberculosis, pleurisy, miliary lesions, lymph node disease, and kidney tuberculosis were common. Involvement of two organs were present in 72% （ 18/25 ） of the patients. Radiology showed soft lesions, miliary nodules , pleural effusion, hilar and mediasfinal lymphadenopathy. Bacteriology and histology were used to confirm the diagnosis in most cases. The average time from presentation to diagnosis was 38 d. The effective rate of therapy was 76% （ 19/25 ）. Conclusion More attention should be paid to tuberculosis after organ transplantation and immunosuppression. Prompt diagnosis and treatment are important measures to reduce the mortality.