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实体器官移植候选者与受者的结核病

Author
Aruna Subramanian, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD
Translators
刘红, 主任医师

引言

实体器官移植受者结核病(tuberculosis, TB)的发病率高于一般人群，但是发病率因地域差异而有所不同[1-3]。在实体器官移植受者中，诊断结核病存在困难，可能导致患者不能得到及时治疗。造成诊断困难的原因包括结核病会出现非典型临床表现，即使存在活动性结核病，结核菌素皮肤试验(tuberculin skin test, TST)和/或γ-干扰素释放试验(interferon-gamma release assay, IGRA)阴性以及痰涂片结果为阴性的可能性也会增加[4-9]。器官移植受者结核病的治疗本身就充满困难，这些困难包括免疫抑制剂与抗结核药物之间药代动力学上的相互作用、同种异体移植相关的药物毒性、外源性免疫抑制导致的机体无法对结核分枝杆菌(Mycobacterium tuberculosis)产生充分的免疫应答[4-7]。

本专题将总结实体器官移植受者的结核分枝杆菌感染。实体器官移植受者非结核分枝杆菌感染，肺移植受者的细菌性、病毒性及真菌性感染，以及实体器官移植受者感染的评估、治疗和预防见其他专题。 (参见“Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients”和“肺移植术后的细菌感染”和“肺移植受者巨细胞病毒感染的预防”和“肺移植受者巨细胞病毒感染的临床表现、诊断和治疗”和“肺移植后真菌感染”和“实体器官移植前的感染评估”和“Infection in the solid organ transplant recipient”和“实体器官移植中感染的预防”)

流行病学

概述 — 在发达国家，器官移植受者活动性结核病的患病率范围为1.2%-6.4%，但是也曾有报道指出在结核病流行区高达10%-15%[4,5,7,10]。 (参见“Epidemiology of tuberculosis”)

实体器官移植受者的结核病发病率尚未确立，并且随着地域不同会有所差异，但是相较于一般人群，器官移植受者的结核病发病率显著较高[1-3]。一项前瞻性研究纳入来自西班牙16家移植中心的4388例实体器官移植受者，在这些器官移植受者中，结核病的年发病率为512例/100,000例患者，而在一般人群中则为19例/100,000位居民[1]。在实体器官移植受者中，肺移植受者的结核病年发病率最高(2072例/100,000例患者)。

传播 — 在器官移植受者中，结核病的最常见原因是受者的潜伏感染再激活，不过也有可能是由同种异体移植物未被识别出的感染或移植后的新发感染导致[4,5,11]。有几篇报道显示，结核病通过同种异体移植物从供者传播至受者[5,11,12]，尤其是当供者来自结核病高度流行的国家时[13]。

             

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Literature review current through: 2017-06 . | This topic last updated: 2016-08-20.
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