泌尿系结核28例临床分析.docVIP

泌尿系结核28例临床分析 熊少兵 汪菁（通信作者） 高吴阳 （湖北省宜昌市三峡大学仁和医院443001） 【摘要】目的：提高泌尿系结核的诊断水平。方法：回顾性分析28例泌尿 系结核患者的临床资料，总结其诊断经验。结果：静脉肾盂造影检出率53.5%、 CT平扫+增强检出率64.2%,膀胱镜膀胱粘膜活检检出率70%,在泌尿系结核感 染病例中有较高的阳性率。尿沉渣找抗酸杆菌阳性率较低22.2%,血结核抗体, PPD试验及B超检查对泌尿系结核感染诊断的特异性较低。结论：泌尿系结核的 临床诊断应综合分析临床表现、尿液和血液检查、影像学检查、病原学检查，诊 断性抗结核治疗等多方面资料，才能更好的做出判断。 【关键词】 泌尿系结核；结核分支杆菌；膀胱镜；膀胱黏膜活检；影像学 检查；诊断方法 【中图分类号】R527 【文献标识码】A 【文章编号】2095-1752 （2015） 10-0084-02 The clinical study of 28 cases of urinary system tuberculosis [Abstract] Objective To in crease the diag no Stic level of urinary system tuberculosis. Methods Retrospectively analysed the clinical data of 28 patients with urin ary tract tuberculosis, and summed up the experie nces of the diag no sis. Results The intravenous urography imaging detection rate of urinary tuberculosis was about 53.5%, CT scan plus enhanced detection rate was about 64.2%, and cystoscope bladder mucosa biopsy detection rate was approximate 70%, these methods had higher positive detection rate in the urinary tract tuberculosis. The urinary sediment detection rate of acid fast stains was low, just only 22.2%, Tuberculosis antibody, PPD test, and type B ultrasonic exami nation showed lower diag nostic specificity for urin ary tract tuberculosis. Con elusions: The accurate clin ical diag nosis of urin ary system tuberculosis should be based on the comprehensive analysis of clinical manifestatio ns, urine and blood tests, imagi ng exami nation, etiology exami nation, and diag no Stic an ti-tuberculosis treatme nt. 【Key words] urinary tuberculosis, mycobacterium tuberculosis, cystoscope, bladder mucosa biopsy, imaging examination, diagnostic method 为提高泌尿系结核的诊断水平，笔者冋顾性分析2005?2009年收治的28 例泌尿系结核患者的临床资料，并总结其诊断经验，现报告如下。 ?资料与方法 1.1临床资料 本组28例，男19例.女9例，年龄27?68岁，平均40岁。病程1?18 个月，平均5个月。肾结核28例，左侧20例，右侧8例。其中并膀胱结核3 例，附睾结核1例，膀胱挛缩1例，对侧肾积水I例，肺结核5例。主诉尿路刺 激征20例，血尿15例，肾区疼痛或不适10例.脓尿3例，阴囊肿块1例，发 热、乏力、盗汗5例，部分病人症状重叠交叉。尿常规异常22例，血沉增快18 例。28例均作尿沉渣涂片找抗酸杆菌检查，5例阳性；15例作尿PCR—TBDNA 检查.5例阳性。 1.2方法 28例均作尿常规，血沉，血结核抗体，尿找抗酸杆菌三次以上，B超、KUB+IVU 检查，