摘要
目的:回顾性分析慢性肾脏病(CKD)患者治疗过程中继发结核病的临床特征及预后。方法:本研究纳入2010年1月至2020年1月国家肾脏疾病临床医学研究中心收治的CKD患者中治疗期间初次确诊结核病(TB)患者71例。比较CKD确诊时和TB确诊时,以及不同免疫水平CKD患者继发TB时的临床和影像学特征。结果:71例患者中男性占60.6%,前三位CKD病因为狼疮性肾炎、膜性肾病和足细胞病。64例曾接受平均2(1,3)种免疫抑制剂治疗。14例合并2型糖尿病或类固醇性糖尿病。TB发病年龄为37.78±16.0岁,确诊TB至CKD起病中位时间为17(8,66)月,出现TB临床症状至确诊TB中位时间14(9,30)d。CKD患者确诊TB时,C反应蛋白显著升高,尿蛋白、低蛋白血症较基线无明显改善。CD4^+T细胞<300个/μl的患者发热和双肺弥漫粟粒性阴影的比例高于CD4^+T细胞≥300个/μl的患者,而肺空洞的比例较低。随访期间36.92%的患者进展至透析治疗,死亡率16.92%。结论:TB多继发于使用免疫抑制剂和合并糖尿病、且尿蛋白不缓解的CKD患者,其临床表现和影像学特征与免疫状态相关,整体预后较差。
Objective:This retrospective cohort study was to evaluate the clinical characteristics and prognosis of patients with tuberculosis tuberculosis(TB)secondary to chronic kidney disease(CKD).Methodology:We retrospectively analyzed patients with TB secondary to CKD who were admitted to the National Clinical Research Center of Kidney Diseases,Jinling Hospital from January 2010 to January 2020.We compared the clinical and imaging features at the time of CKD and TB diagnosed,as well as clinical manifestations according to immune status.Results:Among the 71 patients with TB secondary to CKD,who met the inclusion and exclusion standards of this study,60.5%of them were males,and the first three cause of CKD were lupus nephritis,membranous nephropathy and podocytosis.64 patients had received an average of 2(1,3)types of immunosuppressive therapy.14 patients were type 2 diabetes mellitus or steroid diabetes mellitus.The age at onset of TB was 37.78±16.0 years.The time from diagnosis of TB to onset of CKD was 17(8,66)months,and from initial symptoms of TB to confirm of TB was 14(9,30)days.C-reactive protein was significantly increased,urinary protein and hypoproteinemia were not improved from the onset of CKD to TB diagnosed.Patients with CD4^+T<300/μl had higher rates of fever and pulmonary miliary nodules and lower rates of pulmonary cavity than those with CD4^+T≥300/μl.During follow-up,the dialysis rate was 36.92% and the mortality was 16.92%.Conclusion:TB is mostly secondary to patients with CKD who were combine treated with immunosuppressive drugs or complicared with diabetes,whose urine protein was not remitted.Its clinical and imaging features are related to immune status,and the prognosis is poor.
作者
李喆
陶磊
许书添
胡伟新
王兆峰
袁冬梅
蒋静
李世军
LI Zhe;TAO Lei;XU Shutian;HU Weixin;WANG Zhaofeng;YUAN Dongmei;Jiang Jing;LI Shijun(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China;Department of Medical Imaging,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China;Department of Respiratory Medicine,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2020年第5期426-432,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
江苏省临床医学研究中心课题(YXZXA2016003)
江苏省青年医学重点人才项目(QNRC2016912)
东部战区总医院院管课题(2016027)。
关键词
慢性肾脏病结
核病
免疫抑制剂
chronic kidney disease
tuberculosis
immunosuppressant
