肾移植后的肺结核

Tuberculosis after renal transplantation

背景:肾移植后患者肺结核发病率显著高于正常人群,临床表现不典型,给诊断和治疗带来困难。目的:总结肾移植后肺结核感染的流行病学、临床表现、早期诊断、治疗及预防措施。方法:以"肾移植,肺结核,诊断,治疗,预防"为中文检索词,以"renal transplantation,tuberculosis,diagnosis,therapy,precautionary"为英文检索词,检索中国知网(CNKI)期刊全文数据库、Medline和外文生物医学期刊全文数据库(Foreign Journals Integration System)2001-01/2009-12有关肾移植后肺结核的文章,纳入有关肾移植后肺结核的临床治疗的文献。排除重复性研究和不典型报道。保留39篇文献做进一步分析。结果与结论:肾移植后患者肺结核的诊断需借助胸部X射线、痰涂片或培养、PPD、血Anti-TBAb及PCR等综合检测,结合临床表现是早期诊断的关键。遇临床表现可疑者可行经验性抗结核治疗,一旦确诊调整免疫抑制方案,增加糖皮质激素用量,果断采取抗结核治疗以及营养支持治疗,将有助改善患者的预后。采用适合国人的免疫抑制方案,对高危人群给以预防性化疗或可起到预防作用。

BACKGROUND：The lung tuberculosis incidence of the patients after renal transplantation is much higher than the healthy people.The clinical manifestation is atypical, leading to the difficulty of diagnosis and treatment.OBJECTIVE：To summarize the epidemiology, clinical manifestation, early diagnosis, management and precautionary measures of the patients with tuberculosis after renal transplantation.METHODS：Articles about tuberculosis after renal transplantation were retrieved from CNKI, Medline, and Foreign Journals Integration System with the keye words of ＂renal transplantation, tuberculosis, diagnosis, therapy, precautionary＂ in both Chinese and English from January 2001 to December 2009.Reproductive research and atypical report were excluded.A total of 39 articles were included in the final analysis.RESULTS AND CONCLUSION：The key of early diagnosis depended on chest X-ray, tuberculosis culture, PPD, blood antituberculotic antibody, or PCR combining with clinical manifestation.The empirical treatment was performed for the tuberculosis-suspected patients.Once the diagnosis of tuberculosis was determined, immunosuppressant dosage was adjusted, anti-tuberculosis treatment was decisively performed, and early management with nutrition supply was important for the treatment of patients with tuberculosis after renal transplantation.The proper immunosuppressant dosage would make an empirical treatment to the tuberculosis-suspected patient, and it was also important to decrease the tuberculosis incidence after renal transplantation.