摘要
目的分析细菌性肝脓肿(PLA)患者伴或不伴糖尿病的临床特征,为临床诊疗提供参考。方法回顾性分析2016年5月-2022年2月南通大学附属医院收治的239例PLA患者的临床资料,根据是否合并糖尿病分为糖尿病组(117例)和非糖尿病组(122例),比较两组的一般资料、临床症状和体征、实验室检查结果、影像学特点、入住重症监护病房及住院时间的差异。结果发热是两组患者的主要症状,发热、畏寒寒战、恶心呕吐、乏力两组比较,差异均无统计学意义(P均>0.05)。非糖尿病组腹痛或/和腹部压痛、肝区叩痛的发生率高于糖尿病组(37.70%vs.20.51%,38.52%vs.22.22%),差异有统计学意义(χ^(2)=8.523、7.934,P=0.004、0.005);两组患者出现迁徙性感染、脓毒性休克比较,差异无统计学意义(P>0.05),糖尿病组患者并发脓毒症、急性肾损伤的发生率高于非糖尿病组(54.70%vs.40.16%,23.08%vs.9.02%),差异有统计学意义(χ^(2)=5.063、8.830,P=0.025、0.003)。糖尿病组患者白蛋白、血小板水平低于非糖尿病组[27.3(23.3,31.1)g/L vs.30.9(26.9,33.9)g/L,148.0(78.0,227.5)×10^(9)/L vs.170.5(105.8,273.3)×10^(9)/L],差异有统计学意义(Z=-4.564、-2.174,P<0.001、0.030),D-二聚体水平高于非糖尿病组[3.9(1.9,9.6)mg/L vs.3.2(1.3,7.2)mg/L],差异有统计学意义(Z=-2.328,P=0.020)。两组患者肝脓肿均好发于肝右叶,单个多见,肝脓肿的部位、大小与个数比较,差异均无统计学意义(P均>0.05)。两组均以肺炎克雷伯菌为主要致病菌,糖尿病组肺炎克雷伯菌阳性率高于非糖尿病组(83.87%vs.62.19%),差异有统计学意义(χ^(2)=10.571,P=0.001)。两组患者入住监护病房比较差异无统计学意义(P>0.05),但糖尿病组患者住院时间比非糖尿病组更长[22.0(16.0,29.0)d vs.17.5(13.8,24.0)d],差异有统计学意义(Z=-3.420,P=0.001)。结论PLA合并糖尿病患者临床特征往往不典型,对于糖尿病患者出现不明原因发热,应常规行肝脏影像学检查,尽早发现PLA,肺炎克雷伯菌是最常见感染病原体,应经验性选择覆盖革兰阴性菌的抗生素。
Objective To analyze the clinical features of pyogenic liver abscess(PLA)patients with or without diabetes,and provide reference for clinical diagnosis and treatment.Methods The clinical data of 239 patients with PLA admitted to the Affiliated Hospital of Nantong University from May 2016 to February 2022 were retrospectively analyzed.They were divided into diabetes group(117 cases)and non-diabetes group(122 cases)according to whether they were combined with diabetes.The general information,clinical symptoms and signs,laboratory findings,imaging features,admission to the intensive care unit and the time of hospitalization were compared between the two groups.Results Fever was the main symptom of the two groups of patients,and there was no significant difference in fever,chills,nausea and vomiting,and fatigue between the two groups(all P>0.05).The incidence of abdominal pain,abdominal tenderness and liver percussion pain in the non-diabetes group was higher than those in the diabetes group(37.70%vs.20.51%,38.52%vs.22.22%),the differences were statistically significant(χ^(2)=8.523,7.934,P=0.004,0.005).There was no significant difference in the occurrence of migratory infection and septic shock between the two groups(P>0.05).The incidence of sepsis and acute renal injury in diabetes group was higher than those in non-diabetes group(54.70%vs.40.16%,23.08%vs.9.02%);the differences were statistically significant(χ^(2)=5.063,8.830,P=0.025,0.003).The levels of albumin and platelets in the diabetic group were lower than those in the non-diabetic group[27.3(23.3,31.1)g/L vs.30.9(26.9,33.9)g/L,148.0(78.0,227.5)×10^(9)/L vs.170.5(105.8,273.3)×10^(9)/L];the differences were statistically significant(Z=-4.564,-2.174,P<0.001,0.030),and the level of D-dimer was higher than that in the non-diabetic group[3.9(1.9,9.6)mg/L vs.3.2(1.3,7.2)mg/L];the difference was statistically significant(Z=-2.328,P=0.020).Liver abscesses in the two groups were more common in the right lobe of liver,and there were no significant difference in the location,size and number of liver abscesses(all P>0.05).Klebsiella pneumoniae was the main pathogen in both groups,and the positive rate of Klebsiella pneumoniae in the diabetic group was higher than that in the non-diabetic group(83.87%vs.62.19%);the difference was statistically significant(χ^(2)=10.571,P=0.001).There was no difference between the two groups in admission to intensive care unit(P>0.05),but the hospitalization time of the diabetic group was longer than that of the non-diabetic group[22.0(16.0,29.0)days vs.17.5(13.8,24.0)days];the difference was statistically significant(Z=-3.420,P=0.001).Conclusions The clinical characteristics of patients with PLA complicated with diabetes were often atypical.For patients with diabetes who had unexplained fever,liver imaging examination should be performed routinely to detect PLA as soon as possible.Klebsiella pneumoniae was the most common pathogen of infection,and antibiotics covering gram-negative bacilli should be empirically selected.
作者
赵华
张彬
汤伟
张弦
ZHAO Hua;ZHANG Bin;TANG Wei;ZHANG Xian(Department of Infectious Diseases,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)
出处
《热带医学杂志》
CAS
2023年第11期1541-1545,共5页
Journal of Tropical Medicine
基金
中国博士后科学基金(2020M670041ZX)
南通市科技项目(HS2020001)
关键词
细菌性肝脓肿
糖尿病
肺炎克雷伯菌
发热
Pyogenic liver abscess
Diabetes mellitus
Klebsiella pneumoniae
Fever
