肾移植受者肺外结核的发病及诊治特点分析

Diagnosis and management Of extra-pulmonary tuberculosis in renal transplant recipients

目的探讨肾移植患者术后肺外结核的发病及诊治特点。方法1991年1月至2007年4月行肾移植手术2333例，术后发现结核病37例，经病理学和（或）影像学检查确诊肺外结核者19例（51％）。其中累及移植肾5例、脑膜4例、胸膜4例、淋巴结3例、软组织2例，喉、肝、胸椎、肠道各1例，同时有2个肺外部位受累者3例。发病高峰期为术后1年（53％）。治疗方案主要采用异烟肼、利福平、乙胺丁醇和吡嗪酰胺组合，疗程6～25个月。结果14例经抗结核治疗痊愈，随访1～161个月，患者均存活且无复发；5例患者治疗无效，继发多脏器功能衰竭死亡（26％）。抗结核治疗中发生急性排斥反应8例（42％），肝功能损害4例（21％）。结论肾移植患者术后肺外结核发生率、病死率较高，应引起临床足够重视，使用抗结核药物时应注意兼顾抗结核与抗排斥反应2方面。

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients, and discuss its diagnosis and management. Methods From Jan. 1991 to Apr. 2007, 37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center. Among them there were 19 cases with extra-pulmonary loci （51%）, which involved allograft kidney in 5 cases, meninges in 4 cases, pleura in 4 cases, lymph node in 3 cases, soft issue in 2 cases, larynx, liver, vertebra and intestine in 1 case each. In 3 cases, there were 2 extrapulmonary sites involved at the same time. Most of the cases happened within one year post-transplant （53%）. The most common clinical manifestation was fever. Results After anti-tuberculosis therapy, 14 cases were cured and 5 were irresponsible and died. Eight cases （42%） experienced acute rejection and 4 cases （21%） had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population. Therefore, attention should be given to its differential diagnosis in clinical practice. Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population.