血液透析合并活动性结核感染36 例临床诊治和预后分析

谭祥兰; 梅同华

doi:10.3969/j.issn.1671-4091.2019.12.003

中国血液净化 >

2019 , Vol. 18 >Issue 12: 818 - 821

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.12.003

临床研究

血液透析合并活动性结核感染36 例临床诊治和预后分析

谭祥兰 ,
梅同华

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1重庆医科大学附属第一医院呼吸与危重症医学科

收稿日期: 2018-11-08

修回日期: 2019-09-17

网络出版日期: 2019-12-03

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Clinical features and prognosis of active tuberculosis in patients under hemodialysis

TAN Xiang-Lan ,
MEI Tong-Hua

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1Department of Respiratory and Critical Care Medicine, The First Hospital Affiliated to Chongqing Medical University, Chongqing 400016, China

Received date: 2018-11-08

Revised date: 2019-09-17

Online published: 2019-12-03

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摘要

【摘要】目的探讨血液透析(hemodialysis，HD)患者合并活动性结核感染的临床特点、治疗及预后。方法回顾性分析2014 年1 月1 日～2018 年1 月1 日期间重庆医科大学附属第一医院收治的36 例HD 合并活动性结核感染患者的临床资料，采用Kaplan-Meier 法绘制生存曲线，Log-rank 检验、Cox 回归模型分析进行预后分析。结果36 例患者以发热(58.33%)、肺外结核(72.22%)为主要表现，16 例患者经病原学或组织病检确诊为活动性结核感染，余为临床诊断。其中19 例患者于抗结核治疗过程中出现抗结核药物相关不良反应，以周围神经损伤、球后视神经炎、胃肠道不适为主。随访3 天～48 个月，全因死亡率30.6%，单因素分析发现血清白蛋白＜35g/L、年龄≥60 岁以及合并疾病≥2 个与预后有关(χ2值分别为5.289，13.985，5.266；P 值分别为0.011，0.021，0.022)，COX 多因素分析发现年龄是影响患者预后的独立危险因素(χ2=9.146，P=0.002)。结论HD 患者合并活动性结核感染无特异性的临床表现，抗结核药物不良反应发生率较高，整体预后较差。营养状态、年龄及合并疾病可能是影响患者预后的重要因素。

关键词： 血液透析; 结核; 诊断; 治疗; 预后

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谭祥兰 , 梅同华 . 血液透析合并活动性结核感染36 例临床诊治和预后分析[J]. 中国血液净化, 2019 , 18(12) : 818 -821 . DOI: 10.3969/j.issn.1671-4091.2019.12.003

Abstract

【Abstract】Objective To investigate the clinical features, diagnosis, treatment and prognosis of active tuberculosis in patients undergoing hemodialysis (HD). Methods The clinical data of 36 HD patients with active tuberculosis and treated in the period from Jan. 1, 2014 to Jan. 1, 2018 in our hospital were studied retrospectively. Their survival rates were expressed using Kaplan-Meier curve. Log-rank test and Cox regression model were used to analyze their prognosis. Results The chief clinical manifestations were fever (58.33%) and extra-pulmonary tuberculosis (72.22%) in the 36 patients. The diagnosis was made by the combination of bacteriological and histological methods in 16 cases (44.44%), and by clinical manifestations and other examinations in 20 patients. Nineteen patients (52.78%) developed the side-effects of anti-tuberculosis drugs, including peripheral neuropathy, retro-bulbar neuritis and digestive disorders. Eleven patients (30.56%) died in the follow- up period from 3 days to 48 months. Univariate analyses showed that albumin ＜35g/L (P=0.011), age ≥60 years (P＜0.005) and comorbidities ≥ 2 (P=0.022) were closely related to unfavorable prognosis. Cox regression analysis showed that age was the independent risk factor for prognosis in HD patients with active tuberculosis (P=0.022). Conclusion There were no specific manifestations in HD patients with active tuberculosis. The incidence of side-effects of anti-tuberculosis drugs was higher and the prognosis was poorer in these patients. Nutritional status, age and comorbidities were the important risk factors for prognosis.

Key words： Hemodialysis; Tuberculosis; Diagnosis; Treatment; Prognosis

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