泌尿男性生殖系统结核病诊治随访建议_West China Medical Journal

Authors：

 熊国兵 ,  邱明星

四川省医学科学院·四川省人民医院（电子科技大学附属医院）泌尿外科（成都 610072）;

Corresponding author：

邱明星, Email: 1303624874@qq.com

Keywords：

泌尿系统疾病; 结核病; 肺外结核; 随访

DOI：

10.7507/1002-0179.20160048

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泌尿男性生殖系统结核病（GUTB）患者的治疗包括药物治疗（主要为抗结核化学治疗）与手术治疗，前者与肺结核治疗方案相同。建议随访如下：①初治菌阳者，巩固期末均至少1种推荐性尿结核菌与专科影像学检查，疾病进展或改善不明显性结核菌培养及药物敏感性试验（DST）。若证据表明治疗失败或任何时候发生耐多药结核病，更改治疗方案。注意标本及时规范送检。②复治GUTB患者应强化随访，依据结核菌培养及DST结果调整治疗。③耐多药GUTB患者，除了临床评估，应每个月1次行至少1种推荐性尿结核菌及专科影像学检查，同时，评估药物不良反应，直至证实病情明显改善。④强化患者药物治疗依从性监督，可采用问卷调查、血或尿液药物浓度检查，实施督导干预。⑤潜伏性结核病接受异烟肼化学预防GUTB患者，每3个月接受病理学、尿液结核菌及至少1种确诊性专科影像学评估。⑥每个月接受随访以评估药物不良反应，严重者应停止问题药物使用，并接受结核病专科医院住院治疗。⑦孕妇及哺乳期女性GUTB患者，定期专科随访成人及胎儿情况。对于0 ～ 14岁儿童，影像学检查不作为首选。儿童用药需根据体质量调整。结核菌/艾滋病毒双重感染GUTB患者更容易发生药物不良反应，应加强治疗结果及免疫状态评估。肝、肾功能不全的GUTB患者需依据治疗前检测结果调整用药，密切监测药物不良反应。

Citation： 熊国兵, 邱明星. 泌尿男性生殖系统结核病诊治随访建议. West China Medical Journal, 2016, 31(1): 170-174. doi: 10.7507/1002-0179.20160048 Copy

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1. 那彦群, 叶章群, 孙颖浩. 2014版中国泌尿外科疾病诊断治疗指南[M]. 北京:人民卫生出版社, 2013:455-468.
2. Ghoneim IA, Rabets JC, Mawhorter SD. Chapter 16:tuberculosis and other opportunistic infections of the genitourinary system[M]//Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-Walsh urology[M]. 10th ed. Philadelphia:Elsevier Science Health Science, 2012:468-494.
3. Tuberculosis Coalition for Technical Assistance. International Standards for Tuberculosis Care (ISTC), 2nd edition, 2009[EB/OL]. (2009-01-01)[2014-12-01]. http://www.who.int/tb/ISTC_Report_2ndEd_Nov2009.pdf.
4. 盛吉芳. 肺外结核[C]//第十次全国感染病学术会议暨第二届全国感染科医师大会, 第四届中美临床微生物研讨会论文集. 杭州:中华医学会感染病学分会&中国医师协会感染科医师分会, 2008:24-29.
5. World Health Organization. 4 Monitoring during treatment[M]//World Health Organization. Treatment of tuberculosis:guideline. 4th ed. Geneva:World Health Organization, 2010:53-64.
6. 何礼贤. 肺结核病[M]//王吉耀. 内科学. 2版. 北京:人民卫生出版社, 2011:106-116.
7. 中华医学会结核病学分会. 肺结核诊断和治疗指南[J]. 中国实用乡村医生杂志, 2013, 20(2):7-11.
8. 江红, 臧国庆. 肺外结核[J]. 中华全科医学, 2012, 10(1):103-104.
9. 中华人民共和国卫生部. WS 196-2001 结核病分类标准[S]. 2001.
10. U. S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment Number 208. 4. Medication adherence interventions:comparative effectiveness. closing the quality gap:revisiting the state of the science[M/OL]. Maryland:AHRQ:September 2012:1-685. (2012-09-01)[2015-12-27]. http://www.ncbi.nlm.nih.gov/books/NBK114350/pdf/Bookshelf_NBK114350.pdf.
11. 中国防痨协会. 耐药结核病化学治疗指南(2009)[J].中华结核和呼吸杂志, 2010, 33(7):485-497.
12. International Union Against Tuberculosis and lung Disease. Guidelines for the clinical and operational management of drug-resistant tuberculosis 2013[EB/OL]. (2013-01-01)[2015-12-27]. http://www.theunion.org/what-we-do/publications/technical/english/mdr-tbguide_6-19-13_web.pdf.
13. van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment:a review of reviews[J]. BMC Health Serv Res, 2007, 7:55.
14. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence[J]. Med Care, 1986, 24(1):67-74.
15. WHO. 世界卫生组织结核菌/艾滋病病毒双重感染防治政策指南——适用于国家规划和利益攸关方[EB/OL]. (2012-01-01)[2015-12-27]. http://apps.who.int/iris/bitstream/10665/44789/5/9789245503002_chi.pdf.
16. 高治忠. 泌尿外科主治医生417问[M]. 2版. 北京:中国协和医科大学出版社, 2005:172.
17. 世界卫生组织. 结核病, 实况报道, 第104号.[EB/OL]. (2015-03-01)[2015-12-27]. http://www.who.int/mediacentre/factsheets/fs104/zh/.
18. Karanjekar V, Lokare P, Gaikwad, et al. Treatment Outcome and Follow-up of Tuberculosis Patients Put on Directly Observed Treatment Short-course Under Rural Health Training Center, Paithan, Aurangabad in India[J].Ann Med Health Sci Res, 2014, 4(2):222-226.
19. Karo B, Hauer B, Hollo V, et al. Tuberculosis treatment outcome in the European Union and European Economic Area:an analysis of surveillance data from 2002-2011[J]. Euro Surveill, 2015, 20(48):ES.2015.20.49.30087.
20. van Hest R, Ködmön C, Verver S, et al. Tuberculosis treatment outcome monitoring in European Union countries:systematic review[J]. Eur Respir J, 2013, 41(3):635-643.
21. Stelzmueller I, Huber H, Wunn R, et al. 18F-FDG PET/CT in the initial assessment and for follow-up in patients with tuberculosis[J/OL]. Clin Nucl Med, (2015-12-22)[2015-12-27]. http://www.ncbi.nlm.nih.gov/pubmed/?term=18F-FDG+PET%2FCT+in+the+initial+assessment+and+for+follow-up+in+patients+with+tuberculosis.
22. Gadoev J, Asadov D, Tillashaykhov M, et al. Factors associated with unfavorable treatment outcomes in new and previously treated TB patients in Uzbekistan:a five year countrywide study[J]. PLoS One, 2015,10(6):e0128907.
23. Shuldiner J, Leventhal A, Chemtob D, et al. Mortality after anti-tuberculosis treatment completion:results of long-term follow-up[J]. Int J Tuberc Lung Dis, 2016, 20(1):43-48.

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泌尿男性生殖系统结核病诊治随访建议

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