血液透析发生结核感染的影响因素分析

目的分析维持性血液透析患者发生结核感染的影响因素及临床特点。方法回顾性调查2018年5月-2019年8月北京清华长庚医院肾内科收治的长期规律血液透析患者共150例,收集患者的年龄、性别、合并疾病、血常规、生化、透析充分性等检验结果和影像学资料,归纳分析血液透析患者发生结核感染的影响因素。结果150例血液透析患者,男性91人,女性59人,平均年龄(62.7±14.2)岁,发生结核感染者共11例(7.33%),其中肺外结核比例高(54.5%),以浆膜腔积液为主要表现(54.5%),血红蛋白(94.7±11.6)g/L、血清白蛋白(34.6±2.0)g/L、血肌酐(593.6±221.4)umol/L低于无结核感染者,差异具有统计学意义(P<0.05);血小板(228.7±103.5)×10⁹/L高于无结核感染者,差异具有统计学意义(P<0.05)。两组患者年龄、透析充分性、淋巴细胞、血糖、血脂、血钙、血磷、全段甲状旁腺激素无统计学差异。结论血红蛋白<110g/L、白蛋白<35g/L是MHD患者发生结核感染的高危因素,MHD患者发生结核感染以肺外结核为主,临床表现具有隐匿性和不典型性,临床工作应提高警惕避免漏诊。

Influencing factors of tuberculosis infection in maintenance hemodialysis patients

Objective To investigate the influencing factors and clinical characteristics of tuberculosis infection in maintenance hemodialysis(MHD)patients.Methods 150 MHD patients treated in the Department of Nephrology,Beijing Tsinghua Changgung Hospital from May 2018 to August 2019 were retrospectively investigated.The clinical characters(age,sex,and comorbid disease),biochemical examination(blood routine,biochemistry,and dialysis adequacy index),and radiological images were collected,and the influencing factors of the tuberculosis infection in MHD patients were analyzed.Results Among 150 hemodialysis patients,91were males and 69 were females,with an average age of(62.7±14.2)years,11 cases(7.33%)with tuberculosis infection.Among them,the proportion of extrapulmonary tuberculosis was high(54.5%),and the main manifestation was serous effusion(54.5%).The average level of hemoglobin was(94.7±11.6)g/L,serum albumin was(34.6±2.0)g/L and serum creatinine was(593.6±221.4)umol/L in patients with tuberculosis infection,which were significantly lower than those non-tuberculosis infections.The average level of platelet(228.7±103.5)×10⁹/L was significantly higher than non-tuberculosis infection patients,and the difference was statistically significant(P<0.05).There were no significant differences in ages,kt/v,leukocyte,lymphocyte,blood glucose,serum calcium,serum phosphorus,serum carbon dioxide,serum cholesterol,serum triglycerides,serum parathyroid hormone,and lactate dehydrogenase between the two groups.Conclusion Albumin is less than 35g/L and hemoglobin less than 110g/L were high-risk factors of tuberculosis infection.Extrapulmonary tuberculosis is the main clinical presentation of tuberculosis infection in MHD patients.The clinical manifestations are insidious and atypical,and clinicians should be vigilant and avoid missed diagnoses.