尿毒症患者结核分枝杆菌感染的临床特点分析

Clinical characteristics of Mycobacterium tuberculosis infection in patients with uremia

目的探究尿毒症患者并发结核分枝杆菌感染的临床特点,为临床诊治提供依据。方法选择2013年1月-2015年12月来医院行血液透析的尿毒症患者128例,血液透析治疗期间并发结核菌感染7例,为感染组,余下的121例未感染患者为未感染组;观察并发结核菌感染患者的临床表现及结核发生部位;对比感染组与未感染组血清中尿素清除率(KT/V)、血红蛋白(HB)及白蛋白-球蛋白比值(A/G)、尿素氮(BUN)及肌酐(Scr)水平;对并发结核菌感染患者行胸腹水常规检查及生化项目检查、结核菌素试验(PPD)、抗结合抗体试验。结果 128例尿毒症患者中并发结核分枝杆菌感染7例,感染率为5.47%;临床表现以不明原因发热、腹痛恶心、淋巴结肿大及血红蛋白下降为主,结核发生部位主要为肺外结核,占57.14%;7例尿毒症并发结核分枝杆菌感染患者PPD试验4例患者反应阳性,阳性率为57.14%;在抗结核抗体试验中,有1例患者阳性,阳性率为14.28%;感染组患者血清KT/V、HB、A/G、BUN和Scr均低于未感染组患者,其中HB明显低于未感染患者,两组比较差异有统计学意义(P<0.05);胸腹水检查中,黏蛋白试验(李氏试验)均呈阳性,胸腹水中细胞数偏多,白蛋白总量>30g/L。结论尿毒症并发结核分枝杆菌感染的实验室检查不敏感,需要密切观察,尽早诊断并进行相应治疗。

OBJECTIVE To explore the clinical characteristics of Mycobacterium tuberculosis infection in patients with uremia so as to provide guidance for clinical diagnosis and treatment.METHODS A total of patients with uremia who received hemodialysis in hospitals from Jan 2013 to Dec 2015 were enrolled in the study,7 patients who were complicated with M.tuberculosis infection during the hemodialysis were assigned as the infection group,and the rest of 121 patients without infection were set as the non-infection group.The clinical manifestations and sites of tuberculosis of the patients with complicated with M.tuberculosis infection were observed;the serum urea clearance rate（KT/V）,hemoglobin（HB）level,ratio of albumin to globulin（A/G）,urea nitrogen（BUN）level and creatinine（Scr）were compared between the infection group and the non-infection group.The routine examination and biochemical examination of pleural effusion,tuberculin test（PPD）and anti-tuberculosis antibody test were carried out for the patients complicated with M.tuberculosis infection.RESULTS Of the 128 patients with uremia,7 were complicated with M.tuberculosis infection,with the infection rate 5.47%.The fever of unknown origin,abdominal pain,nausea,lymphadenectasis and decrease of hemoglobin were the major clinical manifestations.The patients with extrapulmonary tuberculosis were dominant among the patients with tuberculosis,accounting for 57.14%.The PPD test was positive in 4 of 7 uremia patients complicated with M.tuberculosis infection,with the positive rate 57.14%;the anti-tuberculosis antibody test was positive in 1 patient,with the positive rate 14.28%.The serum KT/V,HB level,A/G,BUN level and Scr level were lower in the infection group than those in the non-infection group;the HB level of the infection group was significantly lower than that of the non-infection group（P〈0.05）.The result of the pleural effusion examination showed that all the patients showed positive for mucin test（Lee test）,the cells counts were increased in the pleural effusion,and the total albumin concentration was more than 30 g/L.CONCLUSION The laboratory examination is not sensitive for the uremia patients complicated with M.tuberculosis infection,which should be paid close attention to,and it is necessary to diagnose as early as possible and take targeted treatment measures.