去利福平方案在肾移植术后结核菌感染中的临床应用

Clinical application of therapeutic regimen without rifampicin in patients with tuberculosis after kidney transplantation

目的探讨肾移植术后并发结核菌感染的危险因素，及去利福平抗结核方案的治疗效果。方法回顾性分析9例肾移植术后并发结核病患者的临床资料，研究肾移植术后结核菌感染的发生时间、部位及治疗方法。结果结核菌感染发生于术后1．5～17个月，其中3例发生于术后3个月内；7例发生于术后1年内，仅2例发生于术后1年以上。发生肺结核7例；结核性胸膜炎1例；中枢神经系统结核1例。对所有患者均采用异胭肼（INH）、左氧氟沙星、乙胺丁醇和吡嗪酰胺的四联方案治疗9～12个月，治疗后所有患者临床症状均消失，其中有5例患者疗程结束时结核病灶吸收，临床治愈，尚有4例患者仍在随访中。结论肾移植受者是结核菌感染的高发人群；足量、全程的去利福平抗结核治疗方案具有良好的治疗效果。

Objective To explore the risk factors of tuberculosis after kidney transplantation and effects of therapeutic regimen without rifarnpicin on those patients. Methods Retrospective method was used to analyze the clinical data of 9 patients. The onset time, and site and therapeutic methods of tuberculosis after kidney transplantation were studied. Results The mean time to tuberculosis onset was 7 months （range, 1.5 - 17 months） after kidney transplantation. Among them, 3 patients developed tuberculosis within 3 months after transplantation and 7 patients within one year. Only 2 patients developed tuberculosis 〉 1 year after transplantation. Diagnosis of pulmonary tuberculosis was made in 7 patients, tuberculous pleurisy in 1 patient and tuberculosis of central nervous system in 1 patient, respectively. Therapeutic regimen with isoniazid, Ofloxacin, ethambutal and Pyrazinamide was used for 9-12 months. Clinical manifestation disappeared in all patients. Foci of infection were adsorbed in 5 patients who were cured. The remaining 4 patients were still under follow-up. Conclusions Patients after renal transplantation are prone to tuberculosis infection. Full dosage and whole range of therapeutic regimen of anti-tuberculosis without Rifarnpicin has good prospect of application.