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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。
Treatment of patients with urinary and male genital tuberculosis (GUTB) includes medication (mainly anti-TB chemotherapy) and surgery, the former being the same as a tuberculosis regimen. Proposed follow-up are as follows: 1 initial treatment of bacillary positive consolidation at the end of at least 1 kinds of recommended TB and specialist imaging examination, disease progression or improve the non-obvious culture of Mycobacterium tuberculosis and drug sensitivity test (DST). If there is evidence of treatment failure or MDR-TB at any time, change the regimen. Pay attention to the timely submission of specimens specimens. 2 retreatment GUTB patients should be followed up intensively, according to the TB culture and adjustment of the results of DST treatment. 3 In patients with multidrug-resistant GUTB, in addition to the clinical evaluation, at least 1 recommended TB and specialist imaging examination should be conducted once a month. Adverse drug reactions should be assessed once the condition has been significantly improved. 4 to strengthen the compliance of patients with drug treatment supervision can be used questionnaires, blood or urine drug concentration test, the implementation of supervision and intervention. 5 Latent tuberculosis Chemotherapy for isoniazid in patients receiving GUTB is accepted every 3 months for histopathology, M. tuberculosis and at least 1 confirmed specialist imaging assessment. 6 monthly follow-up to assess the adverse drug reactions, serious cases should stop the use of drugs, and admitted to hospital TB hospital. 7 pregnant women and lactating women with GUTB, regular specialist follow-up of adult and fetus. For children aged 0-14, imaging is not preferred. Children medication according to body mass adjustment. Patients with dual mycobacteria / HIV dual infection with GUTB are more likely to have adverse drug reactions and treatment outcomes and assessment of immune status should be strengthened. GUTB patients with liver and renal insufficiency should adjust medication according to pre-treatment test results and closely monitor adverse drug reactions.