維持血液透析患者に発症した結核症の検討

概要

論文の詳細を見る
本論文の著作権は日本透析医学会が保有する。維持血液透析患者に発症した結核症について, その患者背景･診断根拠･治療法を中心に検討した. 対象は導入期を含む維持血液透析患者8例で, 年齢は59.6±4.9歳(28-72歳), 男女比は男性3例, 女性5例. 病巣部位は肺結核が2例, 肺外結核が6例(胸膜炎2例, 頸部リンパ節炎1例, 心外膜炎1例, 脊椎炎1例, 腸結核1例)で, 肺外結核の4例では陳旧性の肺結核病変を認めた. 培養や核酸検査(PCR)法で結核菌を証明できたのは1例のみであり, その他の症例では主に生検組織像や画像所見を根拠として抗結核薬による治療的診断が行われていた. 透析導入から結核発症までの期間は, 糖尿病群4例で6.5±4.0か月(1-10か月), 非糖尿病群4例で108±67.1か月(4-17年)と糖尿病群で有意に短期であった. 初期治療は, 肺結核の2例でisoniazid(lNH), rifampicin(RFP)とstreptomycin(SM)の3剤, 肺外結核の6例でINH, RFPの2剤が併用されており, 全例で治療反応性は良好であった. 透析患者の結核症は肺外結核の割合が高く, 結核菌の証明は困難であり, 積極的な治療的診断が必要であると考えられた. また, 糖尿病合併透析患者では, 特に透析導入早期の結核症発病に注意すべきであることが示唆された.To elucidate the clinical features, diagnosis and treatment efficacy, we examined 8 patients with tuberculosis receiving maintenance hemodialysis in our hospital and affiliated institutions. This study involved three males and five females aged 28 to 72 (59.6±4.9) years. Pulmonary tuberculosis was detected in two patients and extrapulmonary tuberculosis in six (peritonitis, neck lymphadenitis, pericarditis, spondylitis, intestinal tuberculosis). Four of six patients with extrapulmonary tuberculosis had old pulmonary lesions. The duration from initiation of hemodialysis to onset of tuberculosis was significantly shorter in the diabetic group (n=4) than in the non-diabetic group (6.5±4.0 vs 108±67.1 months ; p<0.05). Mycobacterium tuberculosis could be demonstrated in only one patient by culture and polymerase chain reaction (PCR) examination. The other patients had been diagnosed as having tuberculosis based on treatment response and diagnostic imaging or biopsy findings. All patients were successfully treated with anti-tuberculosis drugs ; two patients with pulmonary tuberculosis received three drugs (isoniazid, INH ; rifampicin, RFP ; streptomycin, SM), six with extrapulmonary tuberculosis received INH and RFP. These findings suggest that the incidence of extrapulmonary tuberculosis in hemodialysis patients is high and the onset of tuberculosis in diabetic patients is frequently simultaneous with starting dialysis therapy. Therapeutic diagnosis may be needed in dialysis patients suspected of tuberculosis infection, because it is difficult to detect Mycobacterium tuberculosis by culture or PCR.
日本透析医学会の論文
2004-02-28

維持血液透析患者に発症した結核症の検討

スポンサーリンク

概要

著者

関連論文

スポンサーリンク