Abstract:

 Objective To investigate the clinical manifestations， diagnosis and treatment strategies ofpulmonary mycobacterium tuberculosis （MTB） infection after liver transplantation. Methods Clinical data of7 patients who underwent liver transplantation in Shenzhen Third People's Hospital from January 2018 to January 2021 and complicated with postoperative pulmonary MTB infection were collected， their clinical manifestations， imaging features， diagnosis and treatment methods， and treatment outcomes were analyzed. Results The time of MTBinfection after liver transplantation was 2.5 ～ 48 months， with a median time of 12 months， the infection sites were all in the lungs. Among the 7 cases，5 cases had no obvious clinical symptoms at the time of diagnosis （71.4%）， and 3 caseshad imaging findings of typical MTB infection on lung CT （42.9%）. Tuberculosis （TB） specific antigen was detected in 5 cases （71.4%）， MTB culture was positive in 3 cases （sputum，14.3% ； alveolar lavage fluid in 2 cases，28.6%）， and MTB nucleic acid test was positive in 2 cases （28.6%）. The anti-TB treatment strategies of the 7 patients included HRZE regimen in 1 case，1 case had isoniazid monotherapy，1 case had levofloxacin + isoniazid + ethambutol regimen， 1 case had moxifloxacin + linezolid +ethambutol + isoniazid regimen，2 cases had moxifloxacin + linezolid regimen， and1 case received rifapentine + isoniazid regimen. At follow-up from 2 to 19 months，2 patients died more than 3 months after liver transplantation，3 patients were cured of pulmonary MTB infection， and 2 patients were still receiving anti-TB treatment. Conclusion The clinical manifestations of pulmonary MTB infection after liver transplantation are often atypical and difficult to diagnose， the delayed treatment may lead to poor prognosis. Clinicians should fully recognize this disease， screen and treat it as soon as possible.

Key words:

Liver transplantation； , Tuberculosis； , Mycobacterium； , Lung； , Infection

摘要：

目的 探讨肝移植术后肺部结核分枝杆菌感染的临床表现及诊治策略。方法 收集 2018 年1 月至 2021 年 1 月期间在深圳市第三人民医院接受肝移植手术，且术后合并肺部结核分枝杆菌感染的 7 例病例临床资料，分析其临床表现、影像学特征、诊疗方法及治疗结局。结果 肝移植术后发生结核分枝杆菌感染的时间为术后 2.5 ～ 48个月，中位时间为 12 个月，感染部位均在肺部。7 例病例中有 5 例在确诊时无明显临床症状（占比 71.4%），有 3 例肺部 CT 有典型结核杆菌感染的影像学表现（占比 42.9%）；有 5 例结核特异抗原检测阳性（占比71.4%），3 例结核分枝杆菌培养阳性（痰液 1 例，14.3% ；肺泡灌洗液 2 例，28.6%），2 例结核分枝杆菌核酸检测阳性（占比 28.6%）。7 例病例的抗结核治疗策略有 HRZE 方案 1 例，异烟肼单药 1 例，左氧氟沙星+ 异烟肼 + 乙胺丁醇方案 1 例，莫西沙星 + 利奈唑胺 + 乙胺丁醇 + 异烟肼方案 1 例，莫西沙星 +利奈唑胺方案 2 例，利福喷丁 + 异烟肼方案 1 例。随访 2 个月 ~ 19 个月，2 例于肝移植术后 3 个月余死亡，3 例肺部结核分枝杆菌感染治愈，2 例仍在抗结核治疗中。结论 肝移植术后合并肺部结核分枝杆菌感染临床表现常不典型，诊断较困难，延误治疗可致使预后差，临床医生应充分认识此类疾病，及早筛查，及早治疗。

关键词:

肝移植 , 结核分枝杆菌 , 肺部 , 感染