摘要
目的探讨肝移植术后结核病的临床特征。方法回顾性分析2009-04至2021-04医院收治的44例肝移植术后结核病患者的临床资料,对其临床表现、实验室及影像学检查、治疗及预后进行描述性分析。结果患者平均年龄(53.95±9.15)岁,常见症状是发热(52.3%)、咳嗽(50%)、咳痰(36.4%),罹患结核病的中位时间为24(10.00,59.25)个月,其中14例(31.8%)在术后1年内发病。继发性肺结核最常见(68.2%),27.3%的患者合并2种及以上类型的结核,肺外结核和播散性结核发生率分别是25%和15.9%。PPD试验、血结核抗体、γ-干扰素释放试验的阳性率分别为47.4%、75%、67.7%,血结核抗体的阳性率显著高于PPD试验(χ^(2)=4.39,P=0.04)。56.8%患者行侵入性检查,阳性率为92%,确诊率显著高于非侵入性检查(χ^(2)=15.14,P<0.01)。抗结核治疗期间有11例(25%)出现药物性肝损害,住院治疗有效率为90.9%。结论肝移植术后结核病多发生于术后2年内,早期确诊困难,误诊率高,对反复肺部感染者应筛查结核菌感染,疑似病例应及时行诊断性治疗,侵入性检查有助诊断。
Objective To summarize and analyze the clinical features of mycobacterium tuberculosis(MTB)infection in liver transplant recipients.Methods The clinical data of 44 patients with post-transplant tuberculosis in the 8 th Medical Center of PLA General Hospital from April 2009 to April 2021 were retrospectively reviewed,and the clinical manifestations,laboratory results,imaging features,treatment and prognosis were descriptively analyzed.Results The mean age of the patients was(53.95±9.15)years.The most frequently reported symptoms at diagnosis were fever(52.3%),followed by cough(50%)and expectoration(36.4%).The median time between liver transplant and TB diagnosis was 24(10.00,59.25)months,and 14 cases(31.8%)occurred during the first post-transplant year.Secondary pulmonary tuberculosis(68.2%)was the most common,and 27.3%patients had two or more tuberculosis types.The incidence of extra-pulmonary and disseminated tuberculosis was 25%and 15.9%,respectively.The positive rates of PPD test,blood tuberculosis antibody and interferon-gamma release assays are 47.4%,75%,67.7%respectively.The positive rate of blood tuberculosis antibody was significantly higher than that of PPD test(χ^(2)=4.39,P=0.04).56.8%of the patients underwent invasive examination,and the positive rate was 92%.The number of people definitely diagnosed with invasive methods was significantly higher than that with non-invasive methods(χ^(2)=15.14,P<0.01).11 patients(25%)had impaired liver function throughout the course of treatment,and the total effective rate of treatment was 90.9%.Conclusions Tuberculosis is most common after liver transplantation within 2 years.Early diagnosis of tuberculosis after liver transplantation is difficult and the misdiagnosis rate is high,so more attention should be paid to tuberculosis in patients with recurrent pulmonary infection after liver transplantation.Suspected cases should receive diagnostic therapy timely,and invasive examination is helpful in diagnosis.
作者
封立魁
王瑞官
杜国盛
FENG Likui;WANG Ruiguan;DU Guosheng(Hepatobiliary Surgery Department,the Eighth Medical Center of PLA General Hospital,Beijing 100091,China)
出处
《武警医学》
CAS
2022年第6期480-483,488,共5页
Medical Journal of the Chinese People's Armed Police Force
关键词
肝移植
结核病
诊断
Γ-干扰素释放试验
liver transplantation
tuberculosis
diagnosis
interferon-gamma release assays
作者简介
封立魁,硕士,主治医师;通讯作者:王瑞官,E-mail:wangruiguan@sina.com
