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观察了830例慢性肾功能衰竭患者长期随访过程中结核感染的发生情况,以探讨这类患者预防性抗结核治疗的指征。结果表明,既往有来经适当治疗的结核史或活动性结核接触史的患者,结核发生率(33.3%),明显高于无上述病史者(4,5%,P<0.05);胸部X线检查有钙化、硬结灶,胸膜增厚或肺门部阴影者,日后活动性结核的发生率(27.3%)6倍于胸片正常者(4.4%,P<0.01);血清抗结核菌纯蛋白衍生IgG型抗体(抗PPD-IgG)阳性的患者47.4%在病程中出现结核症状,与阴性者的结核发生率(2.3%)相比差异非常显著(P<0.01)。相反,结核菌素皮试阳性或阴性,有或无低蛋白血症,有或无糖尿病及结缔组织病以及老年和非老年患者之间,结核的发生率无明显差异。由此提示,具有前三项中一项或一项以上因素的慢性肾衰患者应视为结核感染的高危人群而给予预防性抗结核治疗。
The incidence of tuberculosis infection during long-term follow-up in 830 patients with chronic renal failure was observed to explore the indications for prophylactic anti-TB therapy in these patients. The results showed that the incidence of tuberculosis (33.3%) was significantly higher than those without previous history (4,5%, P <0.05) in patients with previously treated tuberculosis or active TB history. ; Chest X-ray examination with calcification, focal lesions, pleural thickening or hilar shadow, the incidence of active tuberculosis in the future (27.3%) 6 times normal chest X-ray (4.4%, P <0 .01). 47.4% of patients with positive anti-TB pure protein-derived IgG antibody (anti-PPD-IgG) showed TB symptoms during the course of the disease, which was significantly lower than that of negative ones (2.3%) Very significant (P <0.01). In contrast, there was no significant difference in the incidence of tuberculosis between positive and negative tuberculin skin tests, with or without hypoproteinemia, with or without diabetes and connective tissue disease, and between elderly and non-elderly patients. This suggests that patients with chronic renal failure who have one or more of the first three items should be treated for prophylactic antituberculosis treatment as a high-risk TB population.