Imaging of Renal Tuberculosis in Eastern Taiwan: Correlation with Clinical Course and Different Communities

東台灣腎結核病之影像發現－臨床表現與族群間關連性

梁庭繼(Ting-Kai Leung) ； 盧建泰(Chien- Tai Lu) ； 凌昌明(Chang-Ming Ling) ； 李超群(Chau-Chin Lee) ； 張寶源(Pau-Nyen Chang) ； 李世傑(Sea-Kiat Lee) ； 嚴寶勝(Pao-Sheng Yen) ； 周紹賓(Shou-Bin Chou)

《The Kaohsiung Journal of Medical Sciences》 19卷6期 (2003/06) Pp. 271-277

摘要

花蓮地區是台灣東部較為偏遠的地方，是由不同族群所組成，因而各有不同生活型態與習俗。本文收集之腎結核病例，嚴重程度和預後狀況差距頗大，因此除了從各病例中整理影像的表現特點，也嘗試找出族群間病況的可能差異性。共分析22位患者之檢驗結果、影像、病理及臨床發展情況，選出之病例皆經病理檢查或細菌培養診斷證實，在證實前未接受任何抗結核菌藥治療。另我們針對花東主要族群分成原住民組與非原住民組，亦對經皮下腎臟造口術之臨床效用等項目作分析。從病例影像發現68%有不同程度腎臟鈣化、59%腎盂與腎盞腫大、55%合併胸腔Ｘ光肺結核和41%腎自體切除。兩組在影像表現嚴重程度和臨床預後具統計學上的差異（0.05＞P≧0.00409）。比較腎結核病在不同病理過程中之射影像變化，建議一般胸腔和腹部X光是必要項目，之後如靜脈內尿道攝影術或電腦斷層攝影為進一步的診斷工具。原住民組之所以表現更嚴重是因為平常對疾病的認知以及健康信念不夠，我們建議加強衛教輔導。

關鍵字

腎結核 ； 東台灣 ； 原住民

並列摘要

Hualien, located in eastern Taiwan, is a relatively isolated district. The population is composed of different ethnic communities. Our hospital is the only medical center in eastern Taiwan, so is the most important referral hospital for epidemic diseases. After reviewing our collected cases of renal tuberculosis (TB), we observed a great diversity in staging and outcomes. The aim of this study was to classify different imaging presentations and clinical outcomes in the ethnic communities represented by these cases (non-aboriginal and aboriginal). We retrospectively reviewed 22 cases from 1991 to 2001. We reviewed laboratory data, radiologic reports, and clinical outcomes. Before TB was proved by biopsy or culture, patients were not treated with an anti-TB regimen. Roentgenography showed that 68% of patients had renal calcification, 59% had dilated calyces, 55% had lung involvement, and 41%had auto-nephrectomy. The proportion of mild and severe forms was significantly different between aboriginal and non-aboriginal groups (0.05＞P≧0.00409). From his series, we recommend routine plain film roentgenography, including chest roentgenography and Kidney, ureter, and bladder or abdominal roentgenography, followed by intravenous urography or computerized tomography as investigative tools for renal TB. Based on the significantly different outcomes of the disease between aboriginal and non-aboriginal groups, a stronger health education program for the isolated district in eastern Taiwan is necessary.

並列關鍵字

aborigine ； eastern Taiwan ； renal TB ； renal tuberculosis