实体器官移植术后结核感染的诊断与疗效分析

Diagnosis and Curative Effect of Tuberculosis in Solid Organ Transplantation Patients

目的探讨实体器官移植术后结核感染的临床特点、诊断及治疗方法。方法回顾性分析行实体器官移植术后患者结核感染11例临床资料,其中肝移植术后8例、肾移植术后2例、肝肾联合移植术后1例;结合病史、结核病原学检查、影像资料以及试验性治疗结果综合评价诊断。结果实体器官移植术后结核总感染率1.04%,其感染率分别为肝移植术后8例占0.92%、肾移植术后2例占1.10%、肝肾联合移植1例占7.14%;急性粟粒性肺结核3例(肝、肾移植及肝肾联合移植各1例),单纯浸润性肺结核、结核性胸膜炎、腰椎结核并浸润性肺结核、淋巴结结核各1例,未找到结核病灶4例;采取个体化化疗方案治疗,随访83～1080d;治愈10例,死亡1例。结论实体器官移植术后结核感染临床症状不典型,部分患者缺乏影像学、细菌学或免疫学证据,易致误诊;对于疑似结核感染,诊断性抗结核治疗应尽快实施。

OBJECTIVE To investigate the clinical feature, diagnosis and treatment of tuberculosis in post-solid organ transplantation patients. METHODS The clinical data of 11 patients with tuberculosis post-solid organ transplantation were analyzed retrospectively, in which eight cases were the patients with post-liver transplantation, two cases were the patients with post-kidney transplantation and one patient with post-liver and kidney transplantation. The diaghosis were based on the case history, pathogenic, image and the consequence of diagnostic therapy against tuberculosis were observed. RESULTS Infection rate of tuberculosis after liver transplantation,kidney transplantation and combined liver and kidney transplantation were 0. 92%, 1. 10% and 7.14% ,respectively. The three cases suffered from acute miliary tuberculosis. One case suffered from exudative pulmonary tuberculosis. One case suffered from tuberculosis pleuritis. One case suffered from lymph node tuberculosis. One case suffered from tuberculosis of lumber spine complicating exudative pulmonary tuberculosis. Four cases were not found lesion in their body. Each patient was adopted with individual treatment. The following up were 83 day to 1080 day. One case was died. Ten cases were cured. CONCLUSIONS Tuberculosis patients with post-solid organ transplantation had atypical clinical symptom under immunosuppressive agents. Part of the patients are lacked of evidences from image, bacteriology or immunology. Diagnostic errors are made sometimes. Diagnostic therapy against tuberculosis should be put into practice for the patients with suspicious tuberculosis.