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目的探讨肝移植受者感染结核的诊断与治疗方法。方法回顾性分析北京佑安医院肝移植术后并发结核的6例受者的临床资料。结果肝移植受者术后结核感染发生率为1.62%(6/370),结核感染发生距肝移植手术3～20个月,中位时间11.5个月。其中肺结核4例,骨结核1例,颅内结核1例。肺结核及骨结核病例经影像学检查后确诊,颅内结核应用诊断性治疗后确诊。6例患者抗结核治疗过程中,发生药物性肝损害1例,加用保肝药物后治愈;发生急性排斥反应2例,增加免疫抑制剂用量后急性排斥反应控制。6例结核最终均痊愈。结论肝移植术后感染结核的临床表现多不典型,早期不易明确诊断,对出现不明原因发热、盗汗、体重下降等症状的患者需要高度警惕结核感染。肺结核及骨结核可通过影像学检查明确诊断,颅内结核诊断极为困难,诊断性抗结核治疗可能是明确诊断、抢救患者生命的惟一可行措施。及时抗结核治疗后患者多可治愈。
Objective To investigate the diagnosis and treatment of tuberculosis in recipients of liver transplantation. Methods The clinical data of 6 patients with tuberculosis after liver transplantation in Beijing You’an Hospital were retrospectively analyzed. Results The incidence of postoperative tuberculosis infection in liver transplant recipients was 1.62% (6/370). Tuberculosis infection occurred 3 to 20 months after liver transplantation and the median time was 11.5 months. Including 4 cases of tuberculosis, bone tuberculosis in 1 case, 1 case of intracranial tuberculosis. Tuberculosis and bone tuberculosis cases confirmed by imaging examination, diagnosis of intracranial tuberculosis after diagnosis and treatment. One patient suffered from drug-induced liver injury during the course of anti-TB treatment in 6 patients and was cured after adding hepatoprotective drugs. Two patients developed acute rejection and increased the dosage of immunosuppressive agents to control acute rejection. 6 cases of tuberculosis eventually recovered. Conclusions The clinical manifestations of TB infection after liver transplantation are atypical and not easy to diagnose early. Patients with unexplained fever, night sweats, weight loss and other symptoms need to be highly vigilant against TB infection. Tuberculosis and bone tuberculosis can be clearly diagnosed by imaging examination. It is extremely difficult to diagnose intracranial tuberculosis. Diagnostic anti-TB treatment may be the only feasible measure to diagnose and rescue the patient’s life. Timely anti-TB treatment of patients and more curable.