维持性血液透析患者并发结核性腹膜炎诊治分析

Diagnosis and treatment of tuberculosis peritonitis in patients with maintenance hemodialysis

目的 探讨维持性血液透析患者合并结核性腹膜炎的临床特征和治疗策略.方法 对12例维持性血液透析患者合并结核性腹膜炎的临床资料进行回顾性分析.结果 维持性血液透析患者合并结核性腹膜炎发病隐匿,继往有结核病史4例（33％）,外周血淋巴细胞计数＜1×109/L10例（83％）,腹腔积液细胞分类以淋巴为主,腹腔积液蛋白、腹腔积液腺苷脱氨酶（ADA）、腹腔积液乳酸脱氢酶（lactate dehydrogenase,LDH）均显著升高,其中所有病例腹腔积液蛋白＞2.5 g/dL,9例（75％）腹腔积液ADA＞ 30 U/L,所有病例腹腔积液LDH＞ 90 U/L.12例患者均接受二联（异烟肼＋利福平）或三联（异烟肼＋利福平＋乙胺丁醇）抗结核治疗,每日单次给药法,治疗9个月.10例（83％）好转出院.结论 对维持性血液透析患者合并结核性腹膜炎的患者给予积极抗结核治疗为主的综合治理可取得较好的效果.

Objective To investigate the clinical characteristics and treatment strategies of patients with maintenance hemodialysis and tuberculous peritonitis.Methods The clinical data of maintenance hemodialysis 12 patients combined with tuberculous peritonitis were analyzed retrospectively.Results The pathogenesis of maintenance hemodialysis combined with tuberculous peritonitis was concealed,and history of tuberculosis in 4 cases （33％）,10 cases of peripheral blood lymphocyte count ＜ 1 × 109/L （83％） were found.The classification of peritoneal effusion cell was mainly lymph,and ascites protein,ascites adenosine deaminase （ADA）,intraperitoneal fluid lactate dehydrogenase （LDH） were significantly increased,the protein in all cases of peritoneal effusion ＞ 2.5 g/dL,peritoneal effusion ADA ＞30 U/L in 9 cases （75％）,all cases of peritoneal effusion LDH ＞90 U/L.All 12 patients received two （isoniazid and rifampicin） or triple （isoniazid,rifampicin and ethambutol） anti-tuberculosis treatment,daily single medication for 9 months.Ten patients were discharged with a better health condition.Conclusions Active anti-tuberculosis in the treatment of maintenance hemodialysis patients with tuberculous peritonitis can achieve better results.