137例细菌性肝脓肿患者的临床特征及危险因素分析_蒋红双.pdf

137 例细菌性肝脓肿患者的临床特征及危险因素分析基金项目:广西医科大学教育教学改革立项项目(2019XJGZ07，2020XJGB39);广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190961，Z20201203，Z2020361)作者简介:蒋红双，女，主治医师，医学硕士，研究方向:全科医学与教育。E-mail:329624977 qqcom通信作者:李佳颖。E-mail:648627802 qqcom 本文引用格式 蒋红双，邓敏华，李佳颖，等137 例细菌性肝脓肿患者的临床特征及危险因素分析 J 右江医学，2023，51(1):36-41蒋红双，邓敏华，李佳颖，黄棵，刘小凤，雷卓青，黄婧渝(广西医科大学第二附属医院全科医学科，广西南宁 530007)【摘要】目的探讨细菌性肝脓肿(PLA)的临床特征、危险因素，为 PLA 的早期诊疗提供参考。方法回顾性分析2017 年 1 月至 2021 年 10 月于广西医科大学第二附属医院收治的 137 例细菌性肝脓肿患者的临床资料，根据合并糖尿病情况将患者分为糖尿病组(58 例)和非糖尿病组(79 例)，比较两组临床特征、病原学特点、实验室指标和影像学特征的差异及影响患者预后的危险因素。结果(1)一般资料:糖尿病组与非糖尿病组的年龄、平均住院天数差异均有统计学意义(P005);两组在基础疾病中差异有统计学意义(P005)，合并糖尿病组的基础疾病主要是胆道疾病(2069%)、高血压(3621%)，非合并糖尿病组的基础疾病主要是胆道疾病(1519%)、胆道手术史(1899%)。(2)临床表现:两组在临床表现方面无统计学意义(P005)，均以发热、腹痛、腹胀人数占比高。(3)病原学结果:共检出病原菌 39 例(2662%)，其中肺炎克雷伯菌 22 例，大肠埃希菌 10 例。(4)影像学结果:两组在单个、多个脓肿数量差异无统计学意义(P005)，肝脓肿的分布部位差异无统计学意义(P005)，以单个脓肿为主，102 例(7445%);分布以右叶为主，95 例(6934%)。(5)治疗方法及预后:两组采用单纯抗生素、抗生素+穿刺引流及抗生素+穿刺引流+手术三种治疗方法的差异无统计学意义(P005)，治疗效果差异无统计学意义(P005)，其中治疗方法以单纯抗生素、抗生素+穿刺引流为主。(6)实验室检查:两组 PT 及总胆红素水平差异有统计学意义(P005)，而 WBC、Hb、PLT、中性粒细胞绝对值、中性粒细胞百分比、HCT、APTT、白蛋白、ALT、AST、尿酸组间比较差异无统计学意义(P005)。结论合并糖尿病的细菌性肝脓肿患者临床表现往往更不典型，应将高龄、凝血功能异常的患者纳入早期识别人群，避免误诊及漏诊，及早针对性治疗，降低并发症风险。【关键词】肝脓肿;临床特征;细菌性肝脓肿;危险因素中图分类号:5754文献标志码:ADOI:103969/jissn1003-1383202301006Analysis of clinical characteristics and risk factorsof 137 patients with pyogenic liver abscessJIANG Hongshuang，DENG Minhua，LI Jiaying，HUANG Ke，LIU Xiaofeng，LEI Zhuoqing，HUANG Jingyu(Department of General Medicine，the Second Affiliated Hospital of GuangxiMedical University，Nanning 530007，Guangxi，China)【Abstract】ObjectiveTo investigate the clinical features and risk factors of pyogenic liver abscess(PLA)，so as to pro-vide reference for the early diagnosis and treatment of PLA MethodsThe clinical data of 137 patients with PLA in the Sec-ond Affiliated Hospital of Guangxi Medical University from January 2017 to October 2021 were retrospectively analyzed，andthe patients were divided into diabetic group(58 cases)and non-diabetic group(79 cases)according to the presence of dia-betes The differences in clinical characteristics，etiological characteristics，laboratory indexes，and imaging characteristicsas well as the risk factors affecting the prognosis of patients were compared between the two groups esults(1)Generaldata:there was statistically significant differences in age and average length of hospital stay between the diabetic group andthe non-diabetic group(P005)The difference in underlying diseases between the two groups was statistically significant63右江医学 2023 年第 51 卷第 1 期Chinese Youjiang Medical Journal 2023，Vol51 No1(P005);the underlying diseases in the diabetic group were mainly biliary diseases(2069%)and hypertension(3621%)，and those in the non-diabetic group were mainly biliary diseases(1519%)and biliary surgery history(1899%)(2)Clinical symptoms:there was no statistically significant difference in clinical symptoms between the two groups(P005)，with fever，abdominal pain and abdominal distension accounted for a high proportion of symptoms in both groups(3)Etiological results:39 cases(2662%)were detected with pathogenic bacteria，among which were 22 cases of Klebsiellapneumoniae and 10 cases of Escherichia coli(4)Imaging results:there were no statistically significant differences in thenumber of single and multiple abscesses between the two groups(P005)，there were no statistically significant differencesin the distribution of liver abscesses(P005)，and 102 cases(7445%)were single abscess，and 95 cases(6934%)were mainly distributed in the right lobe(5)Treatment methods and prognosis:there were no statistically significant differ-ences in the three treatment methods of antibiotics alone，antibiotics+puncture drainage，and antibiotics+puncture drainage+surgery between the two groups(P005)and in the treatment effects(P005)，among them，the treatment methods weremainly antibiotics，antibiotics+puncture drainage(6)Laboratory examination:there were statistically significant differencesin the levels of PT and total bilirubin between the two groups(P005)，but no statistically significant differences in WBC，Hb，PLT，neutrophils absolute value，neutrophils percentage，HCT，APTT，albumin，ALT，AST，and uric acid betweenthe two groups(P005)ConclusionThe clinical symptoms of PLA patients with diabetes are usually more atypical Pa-tients with advanced age and abnormal coagulation function should be included in the early identification population to avoidmisdiagnosis and missed diagnosis，and targeted treatments should be implemented early to reduce the risk of complications【Key words】liver abscess;clinical characteristics;pyogenic liver abscess(PLA);risk factors细菌性肝脓肿(pyogenic liver abscess，PLA)是临床中常见的一种感染性肝脏疾病，研究表明其发病率为 109/10 万，合并糖尿病患病率为3724%，平均住院病死率为 96%，病死率与年龄、糖尿病、恶性肿瘤、女性和慢性肾脏病有关1。随着近年来合并糖尿病的 PLA 患者数量逐渐增多，PLA 患者的病死率呈逐年升高趋势2。但由于 PLA 的早期临床特征缺乏特异性，给疾病的诊断和治疗带来了一定的挑战，本研究通过回顾性分析细菌性肝脓肿患者的临床特征及危险因素，以期提升 PLA 的早期诊治水平。1资料与方法1111一一般般资料资料回顾性分析 2017 年 1 月至 2021 年10 月于广西医科大学第二附属医院收治的细菌性肝脓肿患者 137 例。根据合并糖尿病情况将患者分为合并糖尿病组(A 组)58 例和非糖尿病组(B