肾移植术后肺结核临床特点及早期诊断

Clinical characteristics and early diagnosis of pulmonary tuberculosis after renal transplantation

目的探讨肾移植术后并发肺结核感染的临床特点及早期诊断方法,以期为临床早期诊断肺结核提供帮助。方法回顾性分析武汉大学人民医院6例肾移植术后肺结核患者临床资料。结果本院肾移植术后肺结核患病率为0.6%。大多数患者以发热为首发或唯一表现,以低热为主,其中仅2例患者有呼吸道症状。所有患者胸部CT检查中,仅2例患者具有典型肺结核影像学表现,其余4例患者胸部CT无明显特异性。6例患者中仅1例痰涂片抗酸染色阳性,且外周血标本行宏基因组测序发现结核分枝杆菌,仅1例患者PPD试验阳性,4例患者T-SPOT.TB阳性,1例患者最终通过肺组织穿刺活检确诊。结论肾移植术后并发肺结核感染近年来呈不断升高趋势。由于免疫抑制剂影响,大多数肾移植术后肺结核患者临床症状或体征不典型、可缺少呼吸道症状、影像学结果缺乏特异性、传统PPD试验假阴性率高、结核分枝杆菌检出率等均会导致患者早期诊断困难。IGRA试验和宏基因组测序是较新的检测方法,敏感性和特异性高,有利于早期诊断肺结核。同时,定期、反复、多次、多项联合检测有利于早期诊断肺结核。

Objective To analyze the clinical characteristics and early diagnosis methods of pulmonary tuberculosis infection after renal transplantation in order to offer assistances for the early diagnosis of pulmonary tuberculosis. Methods A retrospective study was performed on 6 cases of patients with pulmonary tuberculosis who were admitted from 2005 to 2020. Results The incidence of pulmonary tuberculosis after kidney transplantation in our hospital was 0.6%. Most of the patients had fever as the first or only manifestation, mainly low fever. Only 2 cases of them had respiratory symptoms. Of all the patients, only 2 cases had typical pulmonary tuberculosis imaging changes, and the other 4 cases had no specific imaging performances. Only one of 6 patients was positive for acid fast staining from sputum smear, and mycobacterium tuberculosis was found in peripheral blood samples by m NGS. And only 1 patient was PPD positive, four patients were T-SPOT positive, and one patient was finally confirmed by lung biopsy. Conclusion Pulmonary tuberculosis infection after renal transplantation was increasing in recent years. Due to the influences of immunosuppressive agents, most patients with pulmonary tuberculosis after renal transplantation have atypical clinical symptoms or signs, these patients may lack of respiratory symptoms and specificity in imaging results, they may have high false negative rate of traditional PPD test and low detection rate of mycobacterium tuberculosis. These features lead to difficulties in early diagnosis. IGRA test and m NGS are relatively new detection methods with high sensitivity and specificity, which are conducive to the early diagnosis of tuberculosis. And regular, repeated, multiple joint comprehensive detection is conducive to the early diagnosis of tuberculosis.