摘要
目的总结肝移植术后结核感染的发生率、临床表现和诊治方法。方法回顾分析246例肝移植患者中术后发生结核感染的3例的临床表现、化验检查结果、影像学资料及诊断和抗结核治疗经过。结果肝移植术后结核感染的发生率为1.2%(3/246)。3例中1例为血行播散型肺结核合并结核性胸膜炎;1例为结核性胸膜炎合并肝脏结核,经抗结核治疗痊愈,未再复发;1例术前有结核空洞,术后合并多种细菌感染和真菌感染,死于肺部感染。3例患者的临床表现均不典型,从症状出现到确诊平均历时30d;血清免疫指标均为阴性,PPD试验仅1例阳性;抗结核治疗安全有效,取得了满意疗效。应用抗结核药后免疫抑制剂血药浓度下降,可通过增加免疫抑制剂剂量后可纠正。无一例患者因抗结核药物的肝毒性而需中断治疗。结论肝移植术后结核感染在临床表现、诊断及治疗上有其特殊性,早期诊断、合理治疗预后较好。
Objective To summarize the incidence, clinical presentation, diagnosis and treatment strategy of Mycobacterium tuberculosis （TB） infection in liver transplanted recipients. Methods The data of clinical situation, laboratory examination, imaging, diagnosis and management of 3 patients who were infected TB after liver transplantation were retrospectively analyzed. Results The incidence of TB infection after liver transplantation was 1.2 % （3/246）. One patient had was pulmonary tuberculosis complicated by pleural tuberculosis, one had pleural tuberculosis complicated with tuberculosis in liver. Both of them had recovered after standard antitubereulosis therapy and no relapse up to now. One patient was found to have tuberculous cavity in the lung died of multiple bacterial and fungous infections postoperatively. As clinical presentations of the patients with TB infection were atypical after liver transplantation, it would take about 30d to confirm the final diagnoses after the onset of symptoms. The serologic examination for TB were all negative results in the 3 patients, and the only positive result was of purified protein derivatives （PPD） skin test in one patient. Administration of antituberculous drugs could decrease the plasmic level of immunodepressant, but the level could be kept normal by adjusting the dosage of immunodepressant. In neither of the 3 patients discontinuation of drugs was necessary because of hepatotoxicity of antituberculosis drugs. Anti-TB treatment was effective, safe and feasible. Conelusion The clinical presentation, diagnosis and treatment are specific for patients with TB infection after liver transplantation. Early diagnosis and rational treatment will lead to a better prognosis.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2008年第2期202-204,共3页
Medical Journal of Chinese People's Liberation Army
关键词
肝移植
结核
手术后并发症
liver transplantation
tuberculosis
postoperative complications
