血液透析患者两步结核菌素皮肤试验中的结核菌素皮肤试验结果及增强现象

Tuberculin skin test results and the booster phenomenon in two-step tuberculin skin testing in hemodialysis patients.

作者信息

Dogan Ekrem, Erkoc Reha, Sayarlioglu Hayriye, Uzun Kursat

机构信息

Department of Internal Medicine, Division of Nephrology, Yuzuncu Yil University, Medical Faculty, Van, Turkey.

出版信息

Ren Fail. 2005;27(4):425-8.

PMID:16060131

Abstract

Patients with chronic renal failure are at increased risk for tuberculosis (TB). Centers for Disease Control and Prevention (CDC) have recommended annual skin testing for TB, with tuberculin-purified protein derivative (PPD), in patients with chronic renal failure. Uremia alters the macrophage function, which can lead to anergy for skin tests. The aim of this prospective study was to determine the prevalence of positive tuberculin skin test (TST) and the booster effect of TST in hemodialysis patients living in a relatively underdeveloped portion of the country. Material and Methods. Patients were recruited from Van (Yuzuncu Yil University Hospital, Yuksek Ihtisas Hospital) and the Mus State Hospital). At the time of this study, a total of 143 patients were under hemodialysis treatment in these hemodialysis centers, and among them, 124 were included in the study. Informed consent was obtained before inclusion in the study. A positive PPD was an induration of >10 mm in response to five tuberculin units of PPD (RT23-Tween 80), at 72 h. TST-negative patients received a booster TST 10 days later, approximately 10 cm away from the previous intracutaneous injection. The test dose could not be increased due to unavailability of this kind of preparation. The test was performed and interpreted in the same way. Skin testing was performed in June and December 2003. Patients with known active TB are not included in the study. Testing was not done in hospitalized patients to rule out effects of other disease states. Results. Mean age of the patients was 45.3 +/- 16 (range 13-82) years. All patients were on HD treatment twice (n: 14) or three times (n: 110) weekly. Duration of dialysis before TST was 30 +/- 17 (12-84) months. With the first test (n: 14), 11.3% of the patients showed a positive reaction; the second test added (n: 15) 12.1% more TST-positive patients, reaching a total of (n: 29) 23.4% of the patients with a positive TST. The

摘要

慢性肾衰竭患者患结核病（TB）的风险增加。美国疾病控制与预防中心（CDC）建议对慢性肾衰竭患者每年进行结核菌素皮肤试验，使用结核菌素纯化蛋白衍生物（PPD）。尿毒症会改变巨噬细胞功能，这可能导致皮肤试验无反应。这项前瞻性研究的目的是确定在该国相对欠发达地区接受血液透析的患者中结核菌素皮肤试验（TST）阳性的患病率以及TST的增强效应。材料与方法。患者从凡城（于祖尔耶尔大学医院、尤克谢克伊蒂萨斯医院）和穆什州立医院招募。在本研究开展时，这些血液透析中心共有143例患者正在接受血液透析治疗，其中124例被纳入研究。在纳入研究前获得了知情同意。PPD阳性是指在72小时时，对5个结核菌素单位的PPD（RT23 -吐温80）产生的硬结直径>10毫米。TST阴性的患者在10天后于距前次皮内注射约10厘米处接受增强TST。由于无法获得此类制剂，试验剂量无法增加。试验以相同方式进行和解读。皮肤试验于2003年6月和12月进行。已知患有活动性结核病的患者不纳入研究。未对住院患者进行检测以排除其他疾病状态的影响。结果。患者的平均年龄为45.3±16（范围13 - 82）岁。所有患者每周接受两次（n：14）或三次（n：110）血液透析治疗。TST前的透析时间为30±17（12 - 84）个月。第一次试验（n：14）时，11.3%的患者呈阳性反应；第二次试验又增加了（n：15）12.1%的TST阳性患者，TST阳性患者总数达到（n：29）23.4%。该……