慢性肾脏病患者并发结核病临床特点分析

Analysis on characteristics of tuberculosis in patients with chronic kidney disease

目的回顾性分析慢性肾脏病患者的结核病发生和预后,探讨慢性肾脏病患者并发结核病的临床特点。方法选取2013年1月至2017年12月南方科技大学附属深圳市第三人民医院、深圳大学总医院、深圳市中医院、深圳市人民医院4家医院肾内科与血液净化中心接受慢性肾脏病治疗和透析治疗3个月以上的患者4195例,分为两组,终末期肾病(ESRD)组1169例:肾小球滤过率<15ml/(min·1.73m^(2));非终末期肾病(no-ESRD)组3206例:肾小球滤过率≥15ml/(min·1.73m^(2)),且满足慢性肾脏病的诊断标准,回顾性分析两组患者的结核病发生率、临床特征及预后。结果ESRD组1169例中有57例(4.9%)诊断为活动性结核,其中肺结核36例(63.2%),肺外结核14例(24.6%),肺结核合并肺外结核者7例(12.3%),全因死亡率为8.8%(5/57)。no-ESRD组3026例患者中,有69例(2.3%)诊断为活动性结核,其中肺结核47例(68.1%),肺外结核16例(23.2%),肺结核合并肺外结核6例(8.7%),全因死亡率为2.9%(2/69)。ESRD组与no-ESRD两组比较,发病率和病因分布差异有统计学意义(χ^(2)=19.502、10.076,P=0.000、0.018);而两组患者免疫学检测、结核类型、临床预后方面差异无统计学意义(χ^(2)=0.222、0.530、3.971,P=0.974、0.767、0.137)。结论慢性肾脏病患者并发结核病发生率高,尤以ESRD患者为甚。迫切需要对慢性肾脏病患者进行结核病筛查,以及时诊断和治疗。

Objective To retrospectively analyze the incidence and prognosis of tuberculosis in patients with chronic kidney disease(CKD),and to investigate the characteristics of tuberculosis in patients with CKD.Method Patients who received CKD treatment and dialysis treatment for more than 3 months in the nephrology department and blood purification center of four hospitals in Shenzhen from January 2013 to December 2017 were divided into 2 groups,ESRD group(end-stage renal disease,ESRD):glomerular filtration rate<15ml/(min·1.73m^(2));no-ESRD group(non-end-stage renal disease,no-ESRD):glomerular filtration rate≥15ml/(min·1.73m^(2)),and all patients meet the diagnostic criteria for CKD.The incidence,clinical features and prognosis of tuberculosis in these patients were retrospectively analyzed.Result There were 1169 and 3026 patients in the ESRD group and no-ESRD group respectively.Fifty-seven patients(4.9%)with active pulmonary tuberculosis were diagnosed in the ESRD group,of which 36 patients(63.2%)with pulmonary tuberculosis,14 patients(24.6%)with extrapulmonary tuberculosis,7 patients(12.3%)with pulmonary tuberculosis complicated extrapulmonary tuberculosis.The all-cause mortality rate was 8.8%(5/57)in the ESRD group.Sixty-nine patients(2.3%)with active tuberculosis were diagnosed in the no-ESRD group,of which 47 patients(68.1%)with pulmonary tuberculosis,16 patients(23.2%)with extrapulmonary tuberculosis,and 6 patients(8.7%)with pulmonary tuberculosis complicated extrapulmonary tuberculosis.The all-cause mortality rate was 2.9%(2/69)in the no-ESRD group.Comparing the two groups of ESRD and no-ESRD,the incidence and etiology distribution are statistically significant(χ^(2)=19.502、10.076,P=0.000、0.018);But there was no statistical difference between the two groups in immunological detection,tuberculosis type,and clinical prognosis(χ^(2)=0.222、0.530、3.971,P=0.974、0.767、0.137).Conclusion The incidence of tuberculosis in patients with CKD is high,especially in ESRD patients.There is an urgent need screening tuberculosis for timely diagnosis and treatment in patients with CKD.