摘要
目的分析肝脓肿的临床特点、病原学变化,为诊疗工作提供临床指导。方法回顾性分析2005年3月—2018年7月空军军医大学附属唐都医院收治的371例肝脓肿病例,收集一般人口学特征、实验室检查、影像学检查、病原学检查及预后数据。计数资料采用χ~2检验,采用多元logistic回归分析影响预后的主要因素。结果371例肝脓肿患者中,男女比例2.07∶1,平均年龄(56.5±14.9)岁,合并2型糖尿病108例、胆道疾病71例、心血管疾病69例、肿瘤34例、肝硬化23例、AIDS 15例。发热为首发临床症状,其次为胸痛或背痛。所有患者入院进行APACHEⅡ评分。实验室检查白细胞、中性粒细胞比例及C反应蛋白、降钙素原升高。多有肝功能异常,丙氨酸转氨酶、碱性磷酸酶和谷氨酰转肽酶升高。病原学检查阳性145例,其中肺炎克雷伯菌培养阳性占45.5%,大肠埃希菌29.0%,其他细菌25.5%,大肠埃希菌产超广谱β内酰胺酶(ESBL)阳性率较高。治疗多采用抗生素联合B超引导下穿刺引流,有效率90.3%。昏迷后自动出院4例,死亡5例。logistic多元回归分析发现患者是否合并肿瘤(OR=17.478,P<0.001)和入院APACHEⅡ评分(OR=0.119,P<0.001)是评价肝脓肿预后的显著影响因素。结论肝脓肿多发于老年男性,合并基础疾病者较多,糖尿病、胆道系统疾病是主要易患因素。合并肿瘤患者预后较差。肺炎克雷伯菌和大肠埃希菌为常见病原菌,复发型多见于大肠埃希菌肝脓肿,且产ESBL株多见,临床中针对大肠埃希菌肝脓肿应早期合理选择抗生素。入院APACHEⅡ评分对判断肝脓肿预后有临床价值。
Objective To analyze the clinical features and etiological pattern of pyogenic liver abscesses to guide future diagnosis and treatment.Methods A retrospective analysis was conducted for the patients with bacterial liver abscess who were treated at Tangdu Hospital,the Air Force Medical University from March 2005 to July 2018.The demographic data,laboratory results,radiological findings,etiology,and outcome were collected.The enumeration data were compared by Chi-square test.Multiple logistic regression analysis was used to analyze the prognostic factors.Results A total of 371 patients were included in this analysis.The male/female ratio was 2.07∶1 with a mean age of(56.5±14.9)years.Most of the patients had underlying diseases,including diabetes mellitus in 108 cases,biliary disease in 71 cases,cardiovascular disease in 69 cases,tumor in 34 cases,liver cirrhosis in 23 cases,and AIDS in 15 cases.Fever was the first clinical symptom,followed by chest or back pain.All patients had APACHE II score at baseline.Laboratory tests showed elevation of white blood cell and neutrophils percentage,as well as C-reactive protein and procalcitonin increased.Abnormal liver function tests were identified in most cases,including increased levels of alanine aminotransferase,alkaline phosphatase,and gamma glutamyl aminotransferase.Etiological pathogen was identified in 145 cases,including Klebsiella pneumoniae in 66(45.5%)cases,Escherichia coli in 42(29.0%)cases,and other bacterial pathogens in 37(25.5%)cases.The prevalence of ESBLs-producing strains was higher in the E.coli isolates.Most patients were treated with antibiotics and ultrasound-guided puncture.The treatment was effective in 90.3%of the patients.Four patients discharged from hospital voluntarily after coma.Five patients died.Multiple logistic regression analysis showed that the significant prognostic factors were underlying tumor(OR=17.478,P<0.001)and the APACHE II score at baseline(OR=0.119,P<0.001).Conclusions Liver abscess is more common in elderly men.Underlying disease was identified in most cases.Patients with diabetes mellitus or biliary disease are at high risk of pyogenic liver abscesses.The prognosis is poor in case of underlying tumor.K.pneumoniae and E.coli are the most frequently isolated pathogens.The recurrent liver abscess is mostly associated with E.coli.Most E.coli strains produced ESBLs.Antibiotics should be used reasonably and timely in clinical practice.The APACHE II score on admission is valuable for estimating the prognosis of patients.
作者
姚娜
毕铭辕
康文
连建奇
王临旭
张谷芬
汪春付
YAO Na;BI Mingyuan;KANG Wen;LIAN Jianqi;WANG Linxu;ZHANG Gufen;WANG Chunfu(Department of Infectious Diseases,Tangdu Hospital,the Air Force Medical University,Xi’an 710038,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第3期249-253,共5页
Chinese Journal of Infection and Chemotherapy
基金
陕西省自然科学基金(2014JM2-8151)。
关键词
细菌性肝脓肿
临床特点
预后
pyogenic liver abscess
clinical characteristic
prognosis
