泌尿男性生殖系統結核病診治隨訪建議_West China Medical Journal

Authors：

 熊國兵 ,  邱明星

四川省醫學科學院·四川省人民醫院（電子科技大學附屬醫院）泌尿外科（成都 610072）;

Corresponding?author：

邱明星, Email: 1303624874@qq.com

Keywords：

泌尿系統疾病; 結核病; 肺外結核; 隨訪

DOI：

10.7507/1002-0179.20160048

Video：

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泌尿男性生殖系統結核病（GUTB）患者的治療包括藥物治療（主要為抗結核化學治療）與手術治療，前者與肺結核治療方案相同。建議隨訪如下：①初治菌陽者，鞏固期末均至少1種推薦性尿結核菌與專科影像學檢查，疾病進展或改善不明顯性結核菌培養及藥物敏感性試驗（DST）。若證據表明治療失敗或任何時候發生耐多藥結核病，更改治療方案。注意標本及時規范送檢。②復治GUTB患者應強化隨訪，依據結核菌培養及DST結果調整治療。③耐多藥GUTB患者，除了臨床評估，應每個月1次行至少1種推薦性尿結核菌及專科影像學檢查，同時，評估藥物不良反應，直至證實病情明顯改善。④強化患者藥物治療依從性監督，可采用問卷調查、血或尿液藥物濃度檢查，實施督導干預。⑤潛伏性結核病接受異煙肼化學預防GUTB患者，每3個月接受病理學、尿液結核菌及至少1種確診性專科影像學評估。⑥每個月接受隨訪以評估藥物不良反應，嚴重者應停止問題藥物使用，并接受結核病專科醫院住院治療。⑦孕婦及哺乳期女性GUTB患者，定期專科隨訪成人及胎兒情況。對于0 ～ 14歲兒童，影像學檢查不作為首選。兒童用藥需根據體質量調整。結核菌/艾滋病毒雙重感染GUTB患者更容易發生藥物不良反應，應加強治療結果及免疫狀態評估。肝、腎功能不全的GUTB患者需依據治療前檢測結果調整用藥，密切監測藥物不良反應。

Citation： 熊國兵, 邱明星. 泌尿男性生殖系統結核病診治隨訪建議. West China Medical Journal, 2016, 31(1): 170-174. doi: 10.7507/1002-0179.20160048 Copy

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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.

1. 那彥群, 葉章群, 孫穎浩. 2014版中國泌尿外科疾病診斷治療指南[M]. 北京:人民衛生出版社, 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. 肺外結核[C]//第十次全國感染病學術會議暨第二屆全國感染科醫師大會, 第四屆中美臨床微生物研討會論文集. 杭州:中華醫學會感染病學分會&中國醫師協會感染科醫師分會, 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. 何禮賢. 肺結核病[M]//王吉耀. 內科學. 2版. 北京:人民衛生出版社, 2011:106-116.
7. 中華醫學會結核病學分會. 肺結核診斷和治療指南[J]. 中國實用鄉村醫生雜志, 2013, 20(2):7-11.
8. 江紅, 臧國慶. 肺外結核[J]. 中華全科醫學, 2012, 10(1):103-104.
9. 中華人民共和國衛生部. WS 196-2001 結核病分類標準[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. 中國防癆協會. 耐藥結核病化學治療指南(2009)[J].中華結核和呼吸雜志, 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. 世界衛生組織結核菌/艾滋病病毒雙重感染防治政策指南——適用于國家規劃和利益攸關方[EB/OL]. (2012-01-01)[2015-12-27]. http://apps.who.int/iris/bitstream/10665/44789/5/9789245503002_chi.pdf.
16. 高治忠. 泌尿外科主治醫生417問[M]. 2版. 北京:中國協和醫科大學出版社, 2005:172.
17. 世界衛生組織. 結核病, 實況報道, 第104號.[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, K?dm?n 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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泌尿男性生殖系統結核病診治隨訪建議

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