慢性肾功能衰竭及接受替代治疗病人并发的结核感染

TUBERCULOSIS IN CHRONIC RENAL FAILURE PATIENTS WITH OR WITHOUT RENAL REPLACEMENT THERAPY

为了解慢性肾功能衰竭 (CRF)和接受肾脏替代治疗病人结核感染的发病情况 ,评价监测血清抗PPD IgG和预防性抗结核治疗对这类病人活动性结核发生率的影响 ,作者对 1989年 4月～ 2 0 0 2年 9月间收治的CRF病人 (n =3 3 60 )并发结核的情况进行了分析。其中 1995年 1月～ 2 0 0 2年 9月收治的CRF病人 (n =2 3 82 )均接受血清抗PPD IgG检测 ,对血清抗PPD IgG阳性的高危病人进行为期 1年的预防性抗结核治疗。以 1989年 4月～ 1994年 12月间收治的CRF病人 (n =978)作为历史对照 (未作预防性抗结核治疗 ) ,比较两组活动性结核的发生率。结果提示 ,CRF病人并发结核的总发生率为 2 4% (82 /3 3 60 ) ,感染部位主要为肺外结核 (75 6% ) ,其中以胸膜结核 (2 0 7% )和淋巴结核 (17 1% )最为多见 ,检测血清或浆膜腔积液抗PPD IgG的诊断阳性率为 5 8 5 % ,结核菌DNA PCR阳性率为2 4 2 %。实验阶段CRF病人结核病的总发生率 (1 76% )和播散性结核的发生率 (2 3 % )均明显低于历史对照组 (4 1%和 7 5 % ,P <0 0 5 )。上述结果提示 ,抗PPD IgG是早期诊断CRF活动性结核的有效方法 ,对高危人群进行预防性治疗 。

The purpose of this study was to explore the incidence of tuberculosis (TB) in chronic renal failure (CRF) patients with or without renal replacement therapy and to evaluate the effect of chemoprophylaxis on incidence of active TB. A total of 3360 CRF patients from April 1989 to Sept. 2002 were enrolled in this study. Chemoprophylaxis for TB was given to the patients with increased serum anti PPD IgG levels from Jan. 1995 to Sept. 2002. The prevalence of active TB during this period was compared with that of the historical control group from April 1989 to Dec. 1998 (without prophylaxis). The results showed that the overall incidence of active TB in all patients was 2 4% (82/3360). Extrapulmonary TB was the most common feature (75 6%) with the major infective sites in pleura (20 7%) and lymph node (17 7%). There were 58 5% patients with active TB showing increased serum and/or serous exudate anti PPD IgG levels and 24 2% patients showing positive TB bacillus DNA (PCR). The total incidences of TB (1 76%) and disseminated TB (2 3%) in the chemoprophylaxis group were significantly lower than those in the non chemoprophylaxis group (4 1% and 7 5%, respectively, P <0 05 in all). These results suggest that the measurement of anti PPD IgG is a helpful early diagnostic index for active TB, and chemoprophylaxis for patients with increased anti PPD IgG level might decrease the incidence of active TB in CRF patients.