肾结核112例临床诊断分析

Clinical study on diagnosis of 112 cases with renal tuberculosis

目的：总结肾结核的诊断要点及经验,明确肾结核的诊断策略,以利于肾结核的及时诊断。方法：收集2010年8月-2014年6月我院收治的112例肾结核患者的临床资料并进行回顾性分析。结果：75例（66.9%）患者表现出不同程度的尿路刺激征,是肾结核最常见的临床表现;尿常规检查异常88例（78.6%）;尿抗酸杆菌染色阳性58例（51.7%）;尿结核杆菌培养6例,阳性者3例（50.0%）;尿结核杆菌PCR-TB-DNA检测69例,阳性42例（60.9%）;超声检查105例,确诊肾结核56例（53.3%）;腹部平片＋IVU或逆行插管造影（RU）检查者86例,确诊肾结核55例（64.0%）;88例患者行泌尿系CT扫描,确诊肾结核者68例（77.3%）。32例行尿道膀胱镜或输尿管镜检查并组织活检,其中21例（65.6%）病理检查证实为结核。结论：肾结核发病较从前更为隐匿,对于临床中长期存在的膀胱刺激症状和不明原因的肾积水,应考虑泌尿系统结核的可能。详细收集病史,结合临床多种检查手段,才能及早明确诊断。

Objective：To summarize the key points of diagnosis and experience of renal tuberculosis,and to explore a clear strategy for the diagnosis of the disease.Method：The clinical data of 112 patients with renal tuberculosis from August 2010 to June 2014 were collected and reviewed retrospectively.Result：Seventy-five of 112patients（66.9%）experienced urinary irritation,which is the most common symptom of renal tuberculosis.Routine urine results showed 88 cases were abnormal（78.6%）,and 58 cases were found positive in staining of acid-fast bacilli（51.7%）.Urine culture of mycobacterium tuberculosis was taken in 6patients,and half of them were positive（50.0%）.PCR-TB-DNA testing for mycobacterium tuberculosis was found positive in 42 of 69cases（60.9%）.Renal tuberculosis was diagnosed through ultrasound examination in 56 of 105patients（53.3%）.Abdominal plain film associating IVU or RU was done in 86 cases,eventually 55cases（64.0%）were diagnosed as renal tuberculosis.The diagnosis was confirmed in 68 of 88cases by urinary tract CT scan（77.3%）.Pathologic examination confirmed that 21 of 32patients（65.6%）suffered from renal tuberculosis by cystoscopic or ureteroscopic biopsy.Conclusion：Renal tuberculosis appears more atypical than before,so for those patients who have bladder irritation for a long time or hydronephrosis of unknown cause we should think of the possibility of urological tuberculosis.With detailed history as well as many examination and test methods,we can make a timely diagnosis of urological tuberculosis.