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[多哥慢性血液透析患者中的结核病:10例报告]

[Tuberculosis among chronic hemodialysis patients in Togo: Report of 10 cases].

作者信息

Tsevi Mawufemo Yawovi, Sabi Akomola Kossi, Lawson-Ananissoh Laté Mawuli, Noto-Kadou-Kaza Befa, Amekoudi Eyram Yoan

机构信息

Service de néphrologie et d'hémodialyse, CHU Sylvanus-Olympio, BP 14148, Lomé, Togo.

Service de néphrologie et d'hémodialyse, CHU Sylvanus-Olympio, BP 14148, Lomé, Togo.

出版信息

Nephrol Ther. 2017 Feb;13(1):14-17. doi: 10.1016/j.nephro.2016.07.447. Epub 2016 Nov 11.

Abstract

GOALS

To determine the frequency of tuberculosis among hemodialysis patients in Togo, specify its different localizations and identify its diagnostic and therapeutic difficulties.

PATIENTS AND METHODS

This was a retrospective study over a period of 5 years (2010-2015). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Sylvanus-Olympio University Teaching Hospital in Lomé. The diagnosis of tuberculosis was selected on the basis of clinical and laboratory data. The specific treatment has involved the association of 4 antituberculosis, which was adapted to the renal function.

RESULTS

Of 91 chronic hemodialysis patients treated in Hospital Sylvanus-Olympio hemodialysis center, 10 cases (10.9%) of tuberculosis were diagnosed. The mean age was 37.3±12.8 years, and the sex ratio was 1.5. The median time to onset of tuberculosis after initiation of hemodialysis was 16.8±9 months. Extrapulmonary sites are found in 100% of cases (5 had both peritoneal and pleural localization, only 5 had pleural localization). The tuberculin skin test was positive in 4 patients (40%). The search for Mycobacterium tuberculosis was unsuccessful in all types of samples. Tuberculosis treatment was generally tolerated. Two patients (20%) had died during treatment.

CONCLUSION

Tuberculosis is relatively common in hemodialysis patients. Diagnosis is difficult and may be based on the therapeutic trial.

摘要

目的

确定多哥血液透析患者中结核病的发病率,明确其不同的发病部位,并找出其诊断和治疗方面的难点。

患者与方法

这是一项为期5年(2010 - 2015年)的回顾性研究。研究对象包括洛美市西尔瓦努斯 - 奥林匹奥大学教学医院肾病科定期进行血液透析的患者记录。结核病的诊断基于临床和实验室数据。具体治疗采用了4种抗结核药物联合使用的方案,并根据肾功能进行了调整。

结果

在西尔瓦努斯 - 奥林匹奥医院血液透析中心接受治疗的91例慢性血液透析患者中,诊断出10例(10.9%)结核病患者。平均年龄为37.3±12.8岁,男女比例为1.5。血液透析开始后结核病发病的中位时间为16.8±9个月。100%的病例为肺外发病部位(5例同时有腹膜和胸膜发病,仅5例有胸膜发病)。4例患者(40%)结核菌素皮肤试验呈阳性。在所有类型的样本中均未成功检测到结核分枝杆菌。结核病治疗总体上耐受性良好。2例患者(20%)在治疗期间死亡。

结论

结核病在血液透析患者中相对常见。诊断困难,可能需基于治疗性试验。

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