肺炎克雷伯菌肝脓肿患者临床特征分析*

doi:10.3969/j.issn.1672-5069.2024.01.031

摘要/Abstract

摘要： 目的回顾分析总结细菌性肝脓肿(PLA),特别是肺炎克雷伯菌(KP)肝脓肿患者病原学、影像学表现和治疗效果,以提高对该病的诊治水平。方法 2017年1月～2022年5月我院收治的PLA患者110例,给予抗感染和超声引导下穿刺抽脓治疗,行血或/和脓液培养。采用化学发光法检测血清高敏C反应蛋白(hs-CRP),采用双抗体夹心免疫发光法检测血清降钙素原(PCT);采用Clauss法检测血清纤维蛋白原。结果在本组110例PLC患者中,血培养或脓液培养阳性70例(63.6%),其中KP 48例(68.6%),大肠杆菌7例(10.0%),链球菌4例(5.7%),葡萄球菌3例(4.3%),粪肠球菌3例(4.3%),屎肠球菌2例(2.8%),解鸟氨酸拉乌尔菌、肠炎沙门氏菌和奇异变形杆菌各1例(4.3%);在70例细菌培养阳性的PLA患者中,肺炎克雷伯菌肝脓肿(KPLA)48例,非肺炎克雷伯菌肝脓肿(N-KPLA)22例;KPLA组年龄为58(49,66)岁,显著年轻于N-KPLA组【65(61,74)岁,P<0.05】;KPLA组合并糖尿病、胆系手术史和胆系感染发生率分别为56.2%、8.3%和14.6%,与N-KPLA组的22.7%、27.3%和45.4%比,差异显著(P<0.05);KPLA组血肌酐(sCr)、高敏C反应蛋白(hs-CRP)、降钙素原(PCT)和纤维蛋白原分别为88.7(60.8,115.4)μmol/L、170.5(86.3,240.5)mg/L、20.2(9.8,31.5)ng/L和6.4(5.0,7.8)g/L,与N-KPLA组【分别为100.3(62.3,145.0)μmol/L、132.6(60.6,181.2)mg/L、26.8(13.4,40.6)ng/L和5.3(4.3,7.1)g/L】比,差异具有统计学意义(P<0.05);影像学检查发现,KPLA组薄壁脓腔、脓腔分隔、脓液液化发生率分别为83.3%、62.5%和97.9%,均显著高于N-KPLA组的54.5%、31.8%和72.7%(P<0.05);在48例KPLA患者中,短期治愈率为70.8%,在N-KPLA患者为59.1%,两组住院时间分别为20(15,28)d和22(16,28)d(P>0.05)。结论在PLA患者中,常见的病原体为KP,了解其发病和脓腔特征,给予抗感染和穿刺抽脓治疗,大多预后良好。

关键词: 细菌性肝脓肿, 肺炎克雷伯菌, 穿刺引流, 治疗

Abstract: Objective The purpose of this study was to summarize the clinical features of Klebsiella Pneumonia (KP)-induced bacterial liver abscess (PLA). Methods 110 patients with PLA were encountered in our hospital between January 2017 and May 2022, and all patients were treated by needle puncture and drainage under US guidance at base of intravenous administration of antibiotics. Serum high sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and fibrinogen (Fib) levels were detected. Results Out of the 110 patients with PLA, the bacteria culture found positive in 70 (63.6%) patients, including KP in 48 cases (68.6%), Escherichia Coli in 7 cases (10.0%), Streptococcus in 4 cases (5.7%), Staphylococcus in 3 cases (4.3%), Enterococcus Faecalis in 3 cases (4.3%), Enterococcus Faecalis in 2 cases (2.8%) and others in 3 cases (4.3%); the KP-induced PLA (KPLA) accounted for 68.6% (48/70), and non-KP-induced PLA (N-KPLA) for 31.4% (22/70); the age of patients with KPLA was 58(49,66)yr, much younger than [65(61, 74)yr, P<0.05] in patients with N-KPLA; there were significant differences as respect to the incidences of concomitant diabetes, biliary operation histories and biliary infections between the two groups (56.2%, 8.3% and 14.6% vs. 22.7%, 27.3% and 45.4%, P<0.05); the sCr, serum hs-CRP, PCT and Fib levels in patients with KPLA were 88.7(60.8, 115.4)μmol/L, 170.5(86.3, 240.5)mg/L, 20.2(9.8, 31.5)ng/L and 6.4(5.0, 7.8)g/L, all significant different compared to [100.3(62.3, 145.0)μmol/L, 132.6(60.6, 181.2)mg/L, 26.8(13.4, 40.6)ng/L and 5.3(4.3, 7.1)g/L] in patients with N-KPLA(P<0.05); the imaging scan found that the incidences of thin wall of intrahepatic abscess, separated abscess and liquidation of abscess in patients with KPLA were 83.3%, 62.5% and 97.9%, all much higher than 54.5%, 31.8% and 72.7%(P<0.05) in patients with N-KPLA; the short-term recovery rate in the 48 patients with KPLA was 70.8%, a little bit higher than 59.1% in patients with N-KPLA, and the hospital stay were 20(15, 28)d and 22(16, 28)d(P>0.05) between the two groups. Conclusion The common pathogen of PLA is KP, followed by Escherichia Coli. The clinicians should take the clinical features of PLA, especially those with KP infections, might help making an appropriate measures to deal with it.

Key words: Bacterial liver abscess, Klebsiella Pneumoniae, Puncture drainage, Therapy

郑浩, 王洪剑, 刘晶晶. 肺炎克雷伯菌肝脓肿患者临床特征分析^*[J]. 实用肝脏病杂志, 2024, 27(1): 121-124.

Zheng Hao, Wang Hongjian, Liu Jingjing. Clinical features of Klebsiella Pneumonia-induced bacterial liver abscess[J]. Journal of Practical Hepatology, 2024, 27(1): 121-124.

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肺炎克雷伯菌肝脓肿患者临床特征分析^*

Clinical features of Klebsiella Pneumonia-induced bacterial liver abscess

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