Research status and progress on tuberculosis after solid organ transplantation
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摘要: 结核病是实体器官移植(SOT)术后严重而复杂的感染性疾病。SOT术后长期使用免疫抑制剂,使受者结核感染和结核病发生率升高。由于抗结核药物的肝肾毒性及其与免疫抑制剂之间药物代谢的相互干扰,导致临床诊断和抗结核治疗复杂性明显增加,病死率明显高于非移植结核病患者。SOT术后结核病的流行病学特点包括继发性肺结核、肺外结核和血行播散性肺结核发生率均高于普通人群。SOT术后结核病的临床诊断有其特殊性。由于免疫抑制剂的使用,结核相关的细胞免疫应答反应减弱,从而导致临床症状不典型和实验室检查敏感性降低。发热是其最常见的典型症状。病原学、细胞免疫学、影像学诊断应常规进行。SOT术后结核病的预防包括受者和捐献者评估,潜在结核杆菌感染供者与受者的治疗。严格掌握捐献者捐献和受者移植的适应证,排除活动性结核病。活动性结核病是器官移植和捐献的禁忌证。SOT术后活动性结核病的治疗比较困难,应尽可能在移植前诊断和治疗活动性结核病,筛查中区分移植受者潜伏性结核杆菌感染和无症状的活动性结核病常较困难,本文对移植后活动性结核病治疗的基本原则进行了具体的阐述。
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