探讨泌尿道结核的临床特点及诊断要点。

分析2022年6月17日浙江大学医学院附属第二医院收治的1例以体重下降，反复发热，伴乏力、头痛入院的泌尿道结核患者的临床资料并复习相关文献。

患者系58岁女性，近半年体重下降7.5 kg，1周余前出现发热，午后低热，最高体温37.7 ℃，伴乏力、头痛。胸部CT示：两肺上叶增殖灶及肺内淋巴结，右肺中叶纤维灶，未见结核分枝杆菌感染征象。彩色多普勒超声示：双侧颈部未见明显肿大淋巴结，双侧颈动脉内中膜增厚，双侧椎动脉未见明显异常，双乳腺囊性增生，双侧腋下未见明显肿大淋巴结，胆囊切除术后，肝内外胆管未见明显扩张，肝脏、胰腺、脾脏未见明显异常，双肾、双侧输尿管、膀胱未见明显异常。尿常规：尿隐血阴性，尿红细胞5个/μl。结核分枝杆菌感染T细胞斑点试验（T-SPOT. TB）：MTB抗原（ESAT-6）斑点数5个、MTB抗原（CFP-10）斑点数1个，结果为阴性。结核菌素皮肤试验：风团直径为35 mm × 18 mm，结果为阳性。随机尿查抗酸杆菌阴性，留12 h尿查抗酸杆菌，结果连续2次为阳性。最终患者以泌尿道结核为主诊断出院并转至结核病定点医院进一步治疗。

泌尿道结核早期诊断困难，需结合各种检查结果综合分析临床表现。

To investigate the clinical characteristics and diagnostic points of urinary tract tuberculosis.

The clinical data of a patient with urinary tract tuberculosis who suffered from weight loss, recurrent fever, fatigue and headache, admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on June 17th, 2022 were analyzed and relevant literatures were reviewed.

The patient was a 58-years-old female who has lost 7.5 kg weight in the past six months. The case developed a fever longer than a week ago and a low fever in the afternoon, with a maximum body temperature of 37.7 ℃, and complicated with fatigue and headache. The chest CT scan showed proliferative lesions and lymph nodes in both upper lobes of the lungs, and fibrous lesions in the middle lobe of the right lung, without any signs of Mycobacterium tuberculosis infection. Color doppler ultrasound showed no obvious enlarged lymph nodes in both necks, thickening of the intima media in both carotid arteries, no obvious abnormalities in both vertebral arteries, cystic hyperplasia of both breasts, no obvious enlarged lymph nodes in both armpits. After cholecystectomy, no obvious dilation of the intrahepatic and extrahepatic bile ducts was observed, and no obvious abnormalities were found in liver, pancreas and spleen. No obvious abnormalities were found in both kidneys, ureters and bladder. Urinary routine: negative occult blood in urine, urinary red blood cells was 5 cells/μl. The Mycobacterium tuberculosis infection T cell spot test (T-SPOT.TB) showed 5 spots on MTB antigen (ESAT-6) and 1 spot on MTB antigen (CFP-10), the result was negative, while the purified protein derivative test (PPD) showed a positive result for a wind mass diameter of 35 mm × 18 mm. The result of random urine test for acid fast bacteria was negative, and 12 hours of urine test for acid fast bacteria was positive for 2 consecutive times, and finally the patient was discharged from the hospital with urinary tract tuberculosis infection as the main diagnosis and transferred to the designated tuberculosis hospital for further treatment.

Early diagnosis of urinary tract tuberculosis is difficult and a comprehensive analysis of clinical manifestations and various examination results is required.