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目的探讨慢性肾衰合并结核病的发病率及临床特点。方法统计该科1997~2001年住院慢性肾衰患者合并结核病的有关情况,与同期重庆市有关资料进行对比分析。结果1069例慢性肾衰患者中,合并结核病者49例,其发病率(4592/10万)显著高于我市同期结核病发病率(151/10万,P <0.001),其中半数以上是不典型肺外结核;随着肾衰程度的加重,合并结核的发生率逐渐升高;抗结核抗体和PPD阳性率(12.2%, 14.3%)显著低于普通结核患者(71.3%, 57.1%,P<0.05);2/3倍于常用剂量的抗痨治疗有效,8例抗痨1年以后接受肾移植者预后良好,而2例抗痨不足半年接受肾移植的患者术后症状复发,治疗无效死亡。结论慢性肾衰易合并结核,特别是不典型肺外结核,对于长期发热的慢性肾衰患者,应想到结核,在排除其他发热原因后,可考虑诊断性抗痨治疗,慢性肾衰合并结核患者抗痨治疗1年后肾移植是安全的。
Objective To investigate the incidence and clinical features of chronic renal failure complicated with tuberculosis. Methods Statistics were made on the incidence of tuberculosis complicated with chronic renal failure in hospital from 1997 to 2001, and compared with the relevant data of Chongqing in the same period. Results Among the 1069 patients with chronic renal failure, 49 cases were complicated with tuberculosis and the incidence rate was 4592/10 million, which was significantly higher than that of the same period in our city (151/10 000, P <0.001). More than half were atypical The incidence of tuberculosis increased with the severity of renal failure. The positive rate of anti-tuberculosis antibody and PPD was significantly lower than that of common tuberculosis (71.3% vs 57.1%, P < 0.05); 2/3 times the usual dose of anti-tuberculosis treatment effective, 8 cases of anti-tuberculosis after 1 year of renal transplant recipients with good prognosis, while 2 cases of anti-tuberculosis less than six months after renal transplantation patients with recurrent symptoms, treatment ineffective death . Conclusions Chronic renal failure is complicated by tuberculosis, especially atypical extrapulmonary tuberculosis. Tuberculosis should be considered in patients with long-term chronic renal failure. After excluding other causes of fever, consider diagnostic anti-tuberculosis therapy. Patients with chronic renal failure and tuberculosis Kidney transplantation is safe after 1 year of anti-tuberculosis treatment.