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| 題 名 | 血液透析患者的結核性腹膜炎:合併腹水、高鈣血症及CA125濃度上升--一病例報告及文獻回顧=Tuberculous Peritonitis in a Hemodialysis Patient with Ascites, Hypercalcemia and Increased CA 125: A Case Report and Literature Review |
|---|---|
| 作 者 | 李明義; 吳三江; | 書刊名 | 內科學誌 |
| 卷 期 | 13:3 2002.06[民91.06] |
| 頁 次 | 頁147-153 |
| 分類號 | 415.2774 |
| 關鍵詞 | 結核性腹膜炎; 高鈣血症; 腹水; 血液透析; Tuberculous peritonitis; Hypercalcemia; CA125; Ascites; Hemodialysis; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 長期血液透析(maintenance hemodialysis)患者每年罹患結核病的發生率為一般社區民眾的7至16倍,而臺灣又為結核病的高度流行地區,因此血液透析患者感染結核病應不在少數。會造成高發生率主要是因為腎臟衰竭引起細胞免疫功能缺損所致,而且血液透析患者通常以非典型的症狀來表現,如體重減輕、食慾不振、發燒以及全身虛弱等,而且發作通常較為遲緩,因此常造成診斷上的困難。高鈣血症又為血液透析患者感染結核病的特徵之一,造成高鈣血症的原因主要是因為腎臟外(extrarenal)或異位(ectopic)產生的1,25-dihydroxy-vitamin D3(calcitrio1)增加所致,其來源可能是感染部位的結核性肉芽腫。本病例為一長期血液透析患者的結核性腹膜炎,剛開始是以發燒、食慾不振及全身虛弱等症狀來表現,並且合併有腹水、高鈣血症及血中CA125濃度上升。在住院檢查四週後,因高度懷疑是結核性腹膜炎,便先給予抗結核菌藥物治療。兩天後,發燒消退而且症狀逐漸改善,腹水也慢慢消失。一直到第八週,腹水的結核分枝桿菌培養才呈現陽性,因此才確定為結核性腹膜炎,而高鈣血症及CA125的濃度也在治療兩個月之後恢復正常。藉由此一病例及文獻回顧,我們認為CA125應可作為結核菌感染的輔助診斷工具以及用來作為治療成效的追蹤。 |
| 英文摘要 | The prevalence of tuberculosis in maintenance hemodialysis patients is 7 to 16 times those of the population in community. High prevalence of tuberculosis was noted in Taiwan and outnumbered the published data. This may be due to defective cellular immunity in patients with end-stage renal disease. Signs and symptoms, presenting with loss of body weight, anorexia, malaise and low-graded fever, are non-specific and insidious and the diagnosis of tuberculosis in hemodialysis patients is usually difficult. Hypercalcemia is one of the features of tuberculosis in hemodialysis patients. Several lines of evidence suggest that extrarenal or ectopic production of 1,25-dihydroxyvitamin D3 is involved in the pathogenesis of hypercalcemia in hemodialysis patients with tuberculosis. We report a case of tuberculous peritonitis in a hemodialysis patient with ascites, hypercalcemia and increased serum CA 125 concentration. Serum calcium and CA 125 concentration returned to normal range after antituberculous treatment for two months. According to the published literatures and the presented case, we believe that serum CA 125 concentration may be a adjuvant tool for the diagnosis of tuberculosis and useful in the follow-up of patients after antituberculous treatment. |
本系統中英文摘要資訊取自各篇刊載內容。