摘要
目的探讨泌尿系结核(UTB)误诊原因,提高临床医师对该疾病的认识。方法对2023年2—7月收治的UTB 5例临床资料进行回顾性分析。结果本组中临床表现尿频尿急4例,血尿3例,腰痛3例,发热2例;尿常规异常4例,尿抗酸杆菌涂片阳性1例,24 h尿沉渣GeneXpert MTB/RIF阳性4例,尿分枝杆菌培养阳性4例,血结核感染T细胞斑点试验阳性5例。影像学表现有肾积水、输尿管扩张及尿路钙化4例,膀胱占位1例,肾自截1例。活动性肺结核3例,陈旧性肺结核2例。5例延误诊治时间2~6年。误诊为泌尿系感染合并肾结石2例,泌尿系感染合并膀胱恶性肿瘤1例,肾结石1例,前列腺增生1例;4例确诊后予抗结核治疗,1例未治疗,随访中2例死亡。结论UTB由于临床表现缺乏特异性、早期诊断困难以及临床医师认识不足,容易误诊导致严重后果。对于复杂性尿路感染患者常规抗感染效果不佳,尤其是有胸部影像学异常时,需高度警惕UTB可能。
Objective To explore the causes of misdiagnosis of urinary tuberculosis(UTB)and to improve the understanding of the disease among clinicians.Methods The clinical data of 5 patients with UTB admitted from February to July 2023 were retrospectively analyzed.Results In this group,there were 4 cases of frequent and urgent urination,3 cases of hematuria,3 cases of lumbago and 2 cases of fever.There were 4 cases with abnormal urine routine,1 case with positive urine acidobacter smear,4 cases with positive 24 h urine sediment GeneXpert MTB/RIF,4 cases with positive mycobacterium culture,5 cases with positive T cell spot test of blood tuberculosis infection.The imaging findings included hydronephrosis,ureteral dilation and urinary tract calcification in 4 cases,bladder occupying lesions in 1 case,and autonephrectomy in 1 case.There were 3 cases of active tuberculosis and 2 cases of old tuberculosis.All the 5 cases had delayed diagnosis and treatment for 2-6 years.They were misdiagnosed as urinary tract infection combined with kidney stone in 2 cases,urinary tract infection combined with bladder malignant tumor in 1 case,kidney stone in 1 case,and prostatic hyperplasia in 1 case.Four patients were treated with antituberculosis therapy,one was left untreated,and two died during follow-up.Conclusion Due to the lack of specificity in clinical manifestations,difficulty in early diagnosis,and insufficient understanding of clinicians,urinary tuberculosis is more likely to be misdiagnosed,leading to serious consequences.For patients with complex urinary tract infections and poor conventional anti-infection effects,especially when there are pulmonary imaging abnormalities,it is necessary to be highly vigilant about the possibility of urinary tuberculosis.
作者
谢平
王迎迎
蒋金利
马爽
陈彩萍
XIE Ping;WANG Yingying;JIANG Jinli;MA Shuang;CHEN Caiping(Department of Infection,Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201600,China)
出处
《临床误诊误治》
CAS
2024年第2期1-6,共6页
Clinical Misdiagnosis & Mistherapy
基金
上海市松江区公共卫生体系建设三年行动计划(2023—2025年)(SJGW6-10)。
关键词
结核
泌尿生殖系统
结核分枝杆菌
误诊
泌尿系感染
肾结石
前列腺增生
结核感染T细胞斑点试验
抗结核药
Tuberculosis,urogenital
Mycobacterium tuberculosis
Misdiagnosis
Urinary tract infection
Kidney stones
Prostatic hyperplasia
T cell spot test for tuberculosis infection
Antitubercular agents
