Abstract:

Objective　To explore the clinical principles of diagnosis and treatment for patients with pulmonary tuberculosis after liver transplantation. Methods　The inpatients treated in Guangzhou Chest Hospital from January 2014 to December 2023 were collected, and the data or information related to the clinical symptoms, lesion location involved, duration of diagnosis, number of hospitalizations, length of hospital stay each time, and clinical therapeutic effect of 25 inpatients with pulmonary tuberculosis after liver transplantation (study group) and 31 inpatients with pulmonary tuberculosis but non-organ transplantation (control group) were comparatively analyzed. Among them, there were 55 males and 1 female, ranging in age from 1 to 75 years old, with an average age of 66 years old. χ² test and rank sum test were used for statistical methods. Results　The rates of fever and fatigue and emaciation in the study group were higher than those in the control group [68.0% (17/25) vs. 22.6% (7/31), 56.0% (14/25) vs. 29.0% (9/31)], with statistically significant differences (χ²=11.66 and 4.16, both P<0.05). There were no statistically significant differences between the two groups in the incidences of tuberculosis lesions in thorax and lung (including lung lobes, bronchus, and pleura) and cavity lesions under CT images, but the incidence of extra-pulmonary tuberculosis (lower extremities, abdominal cavity, neck, brain, lumbar vertebra, testis, etc.) in the study group was higher than that in the control group [44.0% (11/25) vs. 3.2% (1/31)], with a statistically significant difference (χ²=13.67, P<0.05). The onset time of tuberculosis in the study group ranged from 3 to 240 months after liver transplantation (P₂₅, P₅₀, and P₇₅ were 24, 40, and 75 months, respectively), and there was no statistically significant difference in the duration of tuberculosis diagnosis or length of hospital stay each time between the two groups (both P>0.05). In the study group, 4 patients died due to advanced tumor, 1 patient had not yet completed the course of treatment by December 2023,but the condition was significantly improved, and the other 20 patients were cured after anti-tuberculosis treatment for 12 to 36 months (P₂₅, P₅₀, and P₇₅ were 14, 15, and 18 months, respectively). In the control group, 1 patient died due to advanced lung cancer, and the other 30 patients were cured after anti-tuberculosis treatment for 6 to 18 months (P₂₅, P₅₀, and P₇₅ were 12, 12, and 14 months, respectively). The length of anti-tuberculosis therapy course of the study group was longer than that of the control group (Z=3.54, P<0.05). The percent of above 3 times hospitalizations were 20.00% (5/25) in the study group, which was higher than 6.45% (2/31) in the control group (χ²=42.83, P<0.05). Conclusions　It is essential to pay close attention to extrapulmonary tuberculosis, complicated disease changes, and long anti-tuberculosis therapy course in patients with pulmonary tuberculosis after liver transplantation.

Key words:

Liver transplantation, Tuberculosis/pulmonary, Clinical features

摘要：

目的　探讨肝移植术后罹患肺结核患者的临床诊疗规律。方法　收集广州市胸科医院2014年1月至2023年12月期间的住院患者资料，对照分析25例肝移植术后肺结核住院患者（研究组）和31例同期非器官移植肺结核住院患者（对照组）的临床症状、病灶累及部位、诊断时长、住院次数、每次住院时长以及临床治疗效果。其中，男55例、女1例，年龄1～75岁，平均年龄66岁。统计学方法应用χ²检验、秩和检验。结果　研究组的发热、疲乏消瘦率均高于对照组［68.0%（17/25）比22.6%（7/31）、56.0%（14/25）比29.0%（9/31）］，差异均有统计学意义（χ²=11.66、4.16，均P<0.05）。CT影像下结核病灶累及胸肺部位（包括肺叶、支气管和胸膜）及空洞病灶情况两组差异均无统计学意义，但肺外（下肢、腹腔、颈、脑、腰椎、睾丸等）结核发生率研究组高于对照组［44.0%（11/25）比3.2%（1/31）］，差异有统计学意义（χ²=13.67，P<0.05）。研究组患者结核病的发生时间在肝移植术后3～240个月（P₂₅、P₅₀、P₇₅分别为24、40、75个月），结核病诊断时长与每次住院时长两组间差异均无统计学意义（均P>0.05）。研究组患者4例因晚期肿瘤不治死亡、1例截至2023年12月尚未完成疗程但病情明显好转，其他20例患者在12～36个月（P₂₅、P₅₀、P₇₅分别为14、15、18个月）抗结核治疗后均已治愈；对照组患者1例因晚期肺癌死亡，其他30例在6～18个月（P₂₅、P₅₀、P₇₅分别为12、12、14个月）抗结核治疗后均已治愈；研究组治疗疗程长于对照组（Z=3.54，P<0.05）。研究组住院3次以上患者占20.00%（5/25），对照组占6.45%（2/31），研究组高于对照组（χ²=42.83，P<0.05）。结论　肝移植术后肺结核患者肺外结核发生率高、病情变化复杂、抗结核治疗疗程长，值得临床密切关注。

关键词:

肝移植, 肺结核, 临床特征