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为了解慢性肾功能衰竭 (CRF)和接受肾脏替代治疗病人结核感染的发病情况 ,评价监测血清抗PPD IgG和预防性抗结核治疗对这类病人活动性结核发生率的影响 ,作者对 1989年 4月～ 2 0 0 2年 9月间收治的CRF病人 (n =3 3 60 )并发结核的情况进行了分析。其中 1995年 1月～ 2 0 0 2年 9月收治的CRF病人 (n =2 3 82 )均接受血清抗PPD IgG检测 ,对血清抗PPD IgG阳性的高危病人进行为期 1年的预防性抗结核治疗。以 1989年 4月～ 1994年 12月间收治的CRF病人 (n =978)作为历史对照 (未作预防性抗结核治疗 ) ,比较两组活动性结核的发生率。结果提示 ,CRF病人并发结核的总发生率为 2 4% (82 /3 3 60 ) ,感染部位主要为肺外结核 (75 6% ) ,其中以胸膜结核 (2 0 7% )和淋巴结核 (17 1% )最为多见 ,检测血清或浆膜腔积液抗PPD IgG的诊断阳性率为 5 8 5 % ,结核菌DNA PCR阳性率为2 4 2 %。实验阶段CRF病人结核病的总发生率 (1 76% )和播散性结核的发生率 (2 3 % )均明显低于历史对照组 (4 1%和 7 5 % ,P <0 0 5 )。上述结果提示 ,抗PPD IgG是早期诊断CRF活动性结核的有效方法 ,对高危人群进行预防性治疗 ,有利于降低这类病人活动性结核的发生率
In order to understand the incidence of tuberculosis infection in patients with chronic renal failure (CRF) and renal replacement therapy and to evaluate the impact of monitoring serum anti-PPD IgG and prophylactic antituberculosis treatment on the incidence of active tuberculosis in these patients, Analyzes were performed on patients with CRF (n = 3 3 60) who were admitted between September and September 2002 with tuberculosis. Among them, CRF patients (n = 2 3 82) admitted to our hospital from January 1995 to September 2002 were all tested for serum anti-PPD IgG. One-year preventive anti-TB treatment. Patients with CRF (n = 978) who were admitted between April 1989 and December 1994 were used as historical controls (no preventive antituberculosis treatment). The incidence of active TB in both groups was compared. The results showed that the overall incidence of concurrent tuberculosis in CRF patients was 24% (82/3 3 60), and the main infection sites were extrapulmonary tuberculosis (75 6%), of which pleural tuberculosis (27.0%) and lymphoid tuberculosis 17 1%) was the most common. The diagnostic positive rate of anti-PPD IgG in sera or serous fluid was 58.5%. The positive rate of DNA PCR in TB was 224.2%. In the experimental phase, the overall incidence of tuberculosis (176%) and disseminated tuberculosis (23%) in CRF patients were significantly lower than those in the historical control group (41% and 75%, P <0 05). These results suggest that anti-PPD IgG is an effective method for the early diagnosis of active tuberculosis CRF, prophylactic treatment of high-risk groups, is conducive to reducing the incidence of active tuberculosis in such patients