超声引导下经皮肝穿刺抽脓法和置管引流法治疗艾滋病并发肝脓肿患者临床效果分析

doi:10.3969/j.issn.1672-5069.2021.04.030

摘要/Abstract

摘要： 目的分析艾滋病(AIDS)并发肝脓肿患者临床特点并观察在超声引导下介入治疗的效果。方法 2013年6月～2019年12月我院诊治的74例肝脓肿患者,其中39例有AIDS基础病,均在内科治疗的基础上采用超声引导下经皮肝穿刺抽脓法(PA)和置管引流法(PCD)治疗。结果两组患者主要临床表现为发热,AIDS患者出现腹痛或腹部不适症状者占56.4%,显著高于非AIDS组的31.4%(P＜0.05);AIDS组和非AIDS组白细胞(WBC)计数分别为7.2×10⁹/L和10.6×10⁹/L ,中性粒细胞百分比分别为73.7%和78.8%(P＜0.05);血清C反应蛋白(CRP)分别为62.8 mg/L和120.9 mg/L(P＜0.05),降钙素原(PCT)分别为0.3 ng/ml和0.4 ng/ml(P＞0.05);AIDS组合并肝外感染者占71.8%,显著高于非AIDS组的48.6%(P＜0.05);AIDS组脓液培养病原菌难度大,种类多,而非AIDS组则以肺炎克雷伯菌为主;AIDS组和非AIDS组脓肿大小分别为9.4±3.6 cm和9.0±3.1 cm(P＞0.05);,AIDS组和非AIDS组治愈率分别为87.2%和94.3%(P＞0.05),两组之间无显著性差异。结论 AIDS并发肝脓肿患者有其特殊的临床特点,采用超声引导下介入治疗安全、可靠、疗效显著。

关键词: 肝脓肿, 艾滋病, 超声引导, 经皮肝穿刺抽脓法, 置管引流法, 治疗

Abstract: Objective The aim of this study was to analyze the clinical application of ultrasound-guided percutaneous aspiration (PA) and percutaneous catheter drainage (PCD) for treatment of liver abscess patients with or without acquired immune deficiency syndrome (AIDS). Methods The clinical data of 74 patients (with underlying AIDS in 39) with liver abscess were admitted to our hospital between June 2013 and December 2019, and all patients underwent PA or/ and PCD for treatment at base of supporting management. Results The main clinical manifestations in the two groups were fever, and the incidence of abdominal pain or abdominal discomfort in AIDS group was 56.4%, significantly higher than that in non-AIDS group (31.4%, P< 0.05); in AIDS group and non-AIDS group, the white blood cell count was 7.2×10⁹/L and 10.6×10⁹/L, and the percentage of neutrophil was 73.7% to 78.8% (P< 0.05); serum C-reactive protein (CRP) levels were 62.8 mg /L and 120.9 mg/L (P< 0.05), while serum procalcitonin levels were 0.3 g/L and 0.4 g/L (P﹥0.05) ; the incidence of extrahepatic infection in AIDS group was 71.8%, significantly higher than 48.6% in non-AIDS group (P< 0.05) ; it was difficult to culture out pathogens from pus from AIDS patients, and the pathogens varied, while the lebsiella pneumoniae was the main pathogen in patients without AIDS; in AIDS group and non- AIDS groups, the size of abscess were 9.4 ± 3.6 cm and 9.0 ± 3.1 cm (P>0.05), the postoperative complications were 17.9% and 8.6%, and the cure rate was 87.2% and 94.3% (P>0.05). Conclusion The patients with AIDS and liver abscess have their unique clinical features, and the interventional therapy under ultrasound guidance is safe, reliable and efficacy.

Key words: Liver abscess, Acquired immune deficiency syndrome, Ultrasound guidance, Percutaneous aspiration, Percutaneous catheter drainage, Therapy

王雪梅, 张瑶, 杨学平, 王玥, 张记. 超声引导下经皮肝穿刺抽脓法和置管引流法治疗艾滋病并发肝脓肿患者临床效果分析[J]. 实用肝脏病杂志, 2021, 24(4): 573-576.

Wang Xuemei, Zhang Yao, Yang Xueping, et al. Clinical application of ultrasound-guided percutaneous aspiration and percutaneous catheter drainage for treatment of liver abscess patients with or without AIDS[J]. Journal of Practical Hepatology, 2021, 24(4): 573-576.

参考文献

[1] Peris J, Bellot P, Roig P, et al. Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65: a retrospective study. BMC Geriatr, 2017, 17(1):161.
[2] Sohn SH, Kim KH, Park HJ, et al. Predictors of mortality in Korean patients with pyogenic liver abscess, a single center,retrospective study. Korean J Gastroenterol, 2016, 67(5):238-244.
[3] Shelat VG, Chia CLK, Yeo CSW, et al. Pyogenic liver abscess: does Escherichia Coli cause more adverse outcomes than Klebsiella Pneumoniae? World J Surg, 2015, 39(10):2535-2542.
[4] Reddy G, Chatterjee A, Brott B, et al. Transdiaphragmatic rupture of hepatic abscess producing purulent pericarditis and pericardial tamponade. Circulation, 2015, 131(1):e1-e2.
[5] 中华医学会感染病学分会艾滋病学组. 艾滋病诊疗指南第三版(2015版). 中华临床感染病杂志, 2015, 8(5):385-401.
[6] 虞胜镭, 翁心华. 成人细菌性肝脓肿的抗感染治疗要点与进展. 实用肝脏病杂志, 2015, 18(4):337-339.
[7] Eastiak MF, Saifullah M,Islam MS, et al. Pigtail catheter in the management of liver abscess. Mymensingh Med J, 2015, 24 (4):770-775.
[8] Ignee A, Jenssen C, Cui XW, et al. Intracavitary contrast-enhanced ultrasound in abscess drainage-feasibility and clinical value. Scand J Gastroenterol, 2016, 51(1):41-47.
[9] González-Alcaide G, Peris J, Ramos JM, et al. Areas of research and clinical approaches to the study of liver abscess. World J Gastroenterol, 2017, 23(2):357-365.
[10] 张慧, 张照如, 李家斌. 细菌性肝脓肿合并糖尿病患者的临床特点. 中华传染病杂志, 2017, 35(6):364-368.
[11] Moore PP, McGowan GF, Sandhu SS, et al. Klebsiella Pneumoniae liver abscess complicated by endogenous endophthalmitis: the importance of early diagnosis and intervention. Med J Aust, 2015, 203(7):300-301.
[12] Malik AA, Bari SU, Rouf KA, et al. Pyogenic liver abscess: changing patterns in approach. World J Gastrointest Surg, 2010, 2(12):395-401.
[13] Whang G, Harris RD, Tchelepi H, et al. Contrast-enhanced ultrasound appearance of hypervirulent klebsiella pneumoniae liver abscesses. J Ultrasound Med, 2020, 39(7):1447-1452.
[14] Singh S, Chaudhary P, Saxena N, et al. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol, 2013, 26(4):332-339.
[15] Luo M, Yang XX, Zhou XP, et al. Distribution of common pathogens in patients with pyogenic liver abscess in China: a meta-analysis. Eur J Clin Microbiol Infect Dis, 2016, 35(10):1557-1565.
[16] 蔡妙甜, 董培玲. 艾滋病合并肝脓肿患者的临床特征及预后相关危险因素. 中华传染病杂志, 2019, 37(3):155-159.
[17] Iannetta M, Savinelli S, Rossi R, et al. Myeloid and lymphoid activation markers in AIDS and non-AIDS presenters. Immunobiology, 2019, 224(2):231-241.
[18] Devarbhavi H, Sebastian T, Seetharamu SM, et al. HIV/AIDS cholangiopathy: clinical spectrum, cholangiographic features and outcome in 30 patients. J Gastroenterol Hepatol, 2010, 25(10):1656-1660.
[19] Guild GN, Moore TJ, Barnes W, et al. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res, 2012, 470(5):1507-1512.
[20] 靳林上, 许冰. 超声引导下经皮穿刺抽脓治疗化脓性肝脓肿患者疗效及其对血清细胞因子水平的影响. 实用肝脏病杂志, 2018, 21(5):765-768.