肾移植术后并发结核的诊治(附10例报告)

DIAGNOSIS AND TREATMENT OF POSTOPERATIVE TUBERCULOSIS IN THE RENAL RECIPIENTS: REPORT OF 10 CASES

1目的 探讨肾移植病人并发结核的临床特点及诊治方法。 2方法 对 10例肾移植病人并发结核的发病特点、诊断方法及治疗效果进行了回顾分析。术后病人常规进行硫唑嘌呤 (Aza)、泼尼松 (Pred)二联 ,或环孢霉素 A(Cs A) ,Aza,Pred三联免疫抑制治疗 ;10例病人均根据临床表现 ,结合 X线检查、PCR扩增结核杆菌 DNA及组织学检查确诊为结核菌感染。给予异烟肼、利福平、乙胺丁醇 ,或异烟肼、利福平、吡嗪酰胺三联药物抗结核治疗。 3结果 治愈 7例 ,死亡 3例。 4结论 肾移植病人并发结核早期诊断困难 ,反复查胸部 X线片、PCR扩增结核杆菌

Objective\ To investigate the clinical features and methods of diagnosis and treatment of postoperative tuberculosis in the renal recipients.\ Methods\ The features of occurrence, methods of diagnosis and results of treatment of postoperative tuberculosis in 10 renal recipients were retrospectively analyzed. The patients underwent renal transplantation were routinely treated with following regiment: azathioprine + prednisolone or cyclosporin + azathioprine + prednisolone. The diagnosis of tuberculosis infection in 10 patients was confirmed based upon the clinical manifestations and the findings of X ray, PCR and histology. Treatment regiment in the renal recipients with confirmed tubreculosis infection included one of the following drugs combination: isoniazid + rifampicin + ethambutol or isoniazid + rifampicin + pyrazinamide.\ Results\ Seven patients recovered and three died.\ Conclusion\ It was difficult to diagnose postoperative tuberculosis of renal recipients in the early stage since the onset symptoms were not so obvious and typical. Repeated examinations of chest X ray and PCR are helpful in diagnosis of tuberculosis. [