尿毒症患者结核分枝杆菌感染的临床特点分析

发布时间：2018-08-13 08:42

【摘要】：目的探究尿毒症患者并发结核分枝杆菌感染的临床特点,为临床诊治提供依据。方法选择2013年1月-2015年12月来医院行血液透析的尿毒症患者128例,血液透析治疗期间并发结核菌感染7例,为感染组,余下的121例未感染患者为未感染组;观察并发结核菌感染患者的临床表现及结核发生部位;对比感染组与未感染组血清中尿素清除率(KT/V)、血红蛋白(HB)及白蛋白-球蛋白比值(A/G)、尿素氮(BUN)及肌酐(Scr)水平;对并发结核菌感染患者行胸腹水常规检查及生化项目检查、结核菌素试验(PPD)、抗结合抗体试验。结果 128例尿毒症患者中并发结核分枝杆菌感染7例,感染率为5.47%;临床表现以不明原因发热、腹痛恶心、淋巴结肿大及血红蛋白下降为主,结核发生部位主要为肺外结核,占57.14%;7例尿毒症并发结核分枝杆菌感染患者PPD试验4例患者反应阳性,阳性率为57.14%;在抗结核抗体试验中,有1例患者阳性,阳性率为14.28%;感染组患者血清KT/V、HB、A/G、BUN和Scr均低于未感染组患者,其中HB明显低于未感染患者,两组比较差异有统计学意义(P0.05);胸腹水检查中,黏蛋白试验(李氏试验)均呈阳性,胸腹水中细胞数偏多,白蛋白总量30g/L。结论尿毒症并发结核分枝杆菌感染的实验室检查不敏感,需要密切观察,尽早诊断并进行相应治疗。
[Abstract]:Objective To explore the clinical characteristics of uremic patients complicated with Mycobacterium tuberculosis infection and provide evidence for clinical diagnosis and treatment. To observe the clinical manifestations and the location of tuberculosis; to compare the serum urea clearance rate (KT/V), hemoglobin (HB) and albumin-globulin ratio (A/G), urea nitrogen (BUN) and creatinine (Scr) levels between the infected group and the uninfected group; to examine the patients with tuberculosis infection by routine examination and biochemical examination, tuberculosis bacteria. Results Among 128 uremic patients, 7 were complicated with Mycobacterium tuberculosis infection, the infection rate was 5.47%; the main clinical manifestations were fever of unknown origin, abdominal pain and nausea, lymphadenopathy and hemoglobin decline, tuberculosis occurred mainly in extrapulmonary tuberculosis, accounting for 57.14%; 7 uremic patients complicated with Mycobacterium tuberculosis. The positive rate of PPD test was 57.14%. In the anti-tuberculosis antibody test, 1 patient was positive, the positive rate was 14.28%. The serum KT/V, HB, A/G, BUN and SCR of the infected group were lower than those of the uninfected group, and HB was significantly lower than those of the uninfected group (P 0.05). Mucoprotein test (Lee's test) was positive, the number of cells in pleural effusion and ascites was on the high side, and the total amount of albumin was 30g/L. Conclusion Laboratory examination of uremia complicated with Mycobacterium tuberculosis infection is insensitive, so it is necessary to observe closely, diagnose and treat it as soon as possible.
【作者单位】：儋州市人民医院肾内科;广东省人民医院肾内科;
【基金】：海南省卫生厅基金资助项目(琼卫2011-94)
【分类号】：R692.5

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