CAJ | 학술논문

背景：肾移植后患者肺结核感染率较高，临床表现缺乏典型性，给诊断和治疗带来不便。 　　目的：总结同种异体肾移植后肺结核感染的诊断和治疗方法。 　　方法：回顾性分析2010年1月至2013年10月期间在南方医科大学珠江医院器官移植科诊断为肾移植后肺结核感染的13例患者相关临床诊断和治疗方法。 　　结果与结论：肾移植后并发肺结核感染的患者发病时间为肾移植后4-120个月，62%(8/13)患者于移植后18个月内发病。患者多以长时间发热为主要的临床表现，常以低热为首发表现。4例根据病史、影像学资料结合病原学阳性确诊，5例根据病史、影像学资料结合肺穿刺活检组织病理学阳性确诊，其余4例根据病史、影像学资料结合实验性抗结核治疗有效而做出临床诊断。患者肺部体征早期不明显，胸部 CT 有助于早期诊断和鉴别诊断。所有患者遵循早期、规律、全程、适量、联合原则进行抗结核治疗，疗程一般6-10个月，经给予联合抗结核感染药物、调整免疫抑制剂及五酯胶囊保肝等综合治疗，13例患者均存活，未出现死亡病例。2例由于感染早期未及时正规治疗，发生急性排斥反应，导致移植肾功能丧失而恢复血液透析，其余患者均痊愈出院，随访6个月肾功能正常(查血肌酐变化)。说明肾移植后并发肺结核病的患者应早发现、早诊断、早治疗。CT引导下穿刺活检可作为肾移植后菌阴肺结核诊断和鉴别的有效且可行的手段。在调整免疫方案和抗结核治疗同时给予五酯胶囊可显著减少钙调神经蛋白抑制剂类药物剂量，减轻钙调神经蛋白抑制剂类药不良反应。
배경：신이식후환자폐결핵감염솔교고，림상표현결핍전형성，급진단화치료대래불편。 　　목적：총결동충이체신이식후폐결핵감염적진단화치료방법。 　　방법：회고성분석2010년1월지2013년10월기간재남방의과대학주강의원기관이식과진단위신이식후폐결핵감염적13례환자상관림상진단화치료방법。 　　결과여결론：신이식후병발폐결핵감염적환자발병시간위신이식후4-120개월，62%(8/13)환자우이식후18개월내발병。환자다이장시간발열위주요적림상표현，상이저열위수발표현。4례근거병사、영상학자료결합병원학양성학진，5례근거병사、영상학자료결합폐천자활검조직병이학양성학진，기여4례근거병사、영상학자료결합실험성항결핵치료유효이주출림상진단。환자폐부체정조기불명현，흉부 CT 유조우조기진단화감별진단。소유환자준순조기、규률、전정、괄량、연합원칙진행항결핵치료，료정일반6-10개월，경급여연합항결핵감염약물、조정면역억제제급오지효낭보간등종합치료，13례환자균존활，미출현사망병례。2례유우감염조기미급시정규치료，발생급성배척반응，도치이식신공능상실이회복혈액투석，기여환자균전유출원，수방6개월신공능정상(사혈기항변화)。설명신이식후병발폐결핵병적환자응조발현、조진단、조치료。CT인도하천자활검가작위신이식후균음폐결핵진단화감별적유효차가행적수단。재조정면역방안화항결핵치료동시급여오지효낭가현저감소개조신경단백억제제류약물제량，감경개조신경단백억제제류약불량반응。
BACKGROUND:The rate of tuberculosis infection was high in patients after renal transplantation. Clinical manifestation is not typical, which brings inconvenience to diagnose. OBJECTIVE:To summarize the diagnosis and therapeutic methods of tuberculosis infection after al ograft renal transplantation. METHODS:Relevant diagnosis and therapeutic method of 13 patients with tuberculosis infection after renal transplantation were retrospectively analyzed in the Department of Organ Transplantation, Zhujiang Hospital of Southern Medical University from January 2010 to October 2013. RESULTS AND CONCLUSION:The onset time was 4-120 months after operation;62%(8/13) patients within 18 months after transplantation. Patients affected long-period fever, mainly low-grade fever. Four cases were identified according to the history, imaging data in combination with positive pathogenic diagnosis. Five cases were identified according to the history, imaging data combined with lung biopsy histopathology. The remaining four cases were identified according to the history, imaging data with experimental effective anti tuberculosis treatment. Early pulmonary symptom was not obvious. Chest CT was helpful in early diagnosis and differential diagnosis. Al patients fol owed early, law, ful , right amount, combined with principles of anti-tuberculosis treatment, and treatment usual y lasted for 6-10 months. They were given combined anti-tuberculosis infection drugs, adjustment of immunosuppressive agents and five-ester capsule for liver protection therapy. Thirteen patients were alive, no deaths. Two cases with early infection without timely treatment suffered from acute rejection, leading to loss of graft function and returned to hemodialysis. The others were cured and left hospital. Renal function was normal after 6-month fol ow-up (serum creatinine). Results indicated that after renal transplantation, patients with pulmonary tuberculosis should be early detected, early diagnosed and early treated. CT guided biopsy can be used as an effective and feasible means for diagnosis and identification of smear negative pulmonary tuberculosis after renal transplantation. Adjustment of immune scheme, anti-tuberculosis treatment and five-ester capsule significantly reduced calcineurin inhibitor dose, and lessened their adverse reactions.