【摘要】目的通过3 例终末期肾病(end-stage renal disease，ESRD)患者合并结核杆菌感染的病例，探讨ESRD 患者结核杆菌感染的不典型性、诊治线索以及治疗时机。方法回顾性分析首都医科大学康复医学院3 例ESRD 患者合并结核感染病例的临床表现、诊治思路、治疗结局，并进行相关文献复习。结果1 例患者因高龄、合并症多、确诊时间晚，最终死亡；1 例经试验性抗结核治疗后症状好转，病情平稳；1 例患者高度疑诊结核性腹膜炎，抗生素腹腔用药5 天无效，拔除腹膜透析管后转为血液透析，同时抗结核治疗1 年，病情平稳。结论ESRD 患者并发结核杆菌感染，临床症状多不典型且以肺外结核多见，如怀疑合并结核杆菌感染，可在密切观察相关药物副作用的前提下，尽早行试验性抗结核治疗，以免延误诊断和治疗时机，导致不良预后。

【Abstract】Objective To investigate the diagnostic criteria of tuberculosis and the suitable period to start treatment in three end stage of renal disease (ESRD) patients complicated with atypical tuberculosis infection. Methods We retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis of 3 ESRD cases complicated with tuberculosis and reviewed the related literature. Results One patient died of old age, complications and too late to be diagnosed. One patient improved after ant-tuberculosis therapy with less symptoms and stable disease conditions. One patient was highly suspected to have tuberculosis peritonitis because of no improvement after intraperitoneal antibiotics for 5 days; after removal of peritoneal dialysis tube and change to hemodialysis and administration of anti-tuberculosis therapy for one year, the patient’s disease condition became stable. Conclusion In ESRD patients complicated with tuberculosis, extra- pulmonary tuberculosis is very common with atypical tuberculosis symptoms. ESRD patients suspected with tuberculosis infection may have a trial of anti-tuberculosis treatment as early as possible under the close surveillance of side- effects of the drugs. Misdiagnosis and delayed treatment of tuberculosis would lead to an adverse prognosis.