合并不同基础疾病的细菌性肝脓肿患者临床特征分析

doi:10.3969/j.issn.1672-5069.2023.03.031

摘要/Abstract

摘要： 目的分析并比较合并不同基础疾病的细菌性肝脓肿(PLA)患者的临床特征。方法自2007年1月～2020年12月我院诊治的成年PLA患者,分析临床特征和结局。结果在1930例PLA患者中,无糖尿病或胆道相关疾病者(A组)926例,有糖尿病者(B组)592例,有胆道疾病者(C组)261例和同时患有这两种疾病者(D组)151例;D组中性粒细胞百分比为(83.6±9.3)％,显著高于其他三组(P<0.05),B组和D组血清白蛋白水平分别为30.3(26.1,35.1)g/L和30.8(26.9,34.1)g/L,显著低于A组【32.3(28.3,36.8)g/L,P<0.05】;C组黄疸占比为11.9％,显著高于A组的5.5％和B组的2.7％(P<0.05),D组肺部病变占比为39.1％,显著高于A组的28.3％(P<0.05),B组和D组产气脓肿占比分别为15.4％和12.6％,显著高于A组的6.6％(P<0.05),D组脓肿直径为68.0(50.0,87.0)mm,显著大于其他三组(P<0.05);B组、C组和D组医疗花费分别为2.2(1.5,3.3)万元、2.3(1.5,3.4)万元和2.4(1.5,4.2)万元,显著高于A组【1.9(1.2,2.9)万元,P<0.05】。结论合并基础疾病的PLA患者感染和消耗更重,住院花费相对较高,其中合并糖尿病患者可能需要更多次的穿刺引流治疗。

关键词: 细菌性肝脓肿, 糖尿病, 胆道疾病, 治疗

Abstract: Objective The purpose of this study was to analyze the clinical features of patients with pyogenic liver abscess (PLA) with different underlying diseases. Methods The adult PLA patients were encountered in our hospital between January 2007 and December 2020, and the clinical materials were collected and analyzed. Results Out of the 1930 patients with PLA in our series, 926 patients (group A) had no underlying diseases, 592 patients (group B) had type two diabetes mellitus (T2DM), 261 patients (group C) had biliary diseases, and 151 patients (group D) had T2DM and biliary diseases; the percentage of neutrophils in group D was (83.6±9.3)％, much higher than in other three groups (P<0.05), serum albumin levels in group B and group D were 30.3(26.1, 35.1)g/L and 30.8(26.9, 34.1)g/L, much lower than [32.3(28.3, 36.8) g/L, P<0.05] in group A; the incidence of jaundice in group C was 11.9％, significantly higher than 5.5％in group A and 2.7％ in group B(P<0.05), the incidence of pulmonary lesions in group D was 39.1％, significantly higher than 28.3％(P<0.05) in group A, the proportions of aerogenic abscess in group B and group D were 15.4％ and 12.6％, significantly higher than 6.6％(P<0.05) in group A, and the diameter of hepatic abscess in group D was 68.0(50.0, 87.0)mm, significantly higher than in other three groups (P<0.05); the medical costs in group B, group C and group D were 20000.2(10000.5,30000.3) yuan, 20000.3(10000.5, 30000.4) yuan and 20000.4(10000.5, 40000.2) yuan, significantly higher than [10000.9(10000.2, 20000.9) yuan (P<0.05) in group A. Conclusion The PLA patients with underlying diseases might have a severe disease, and have a relatively high hospitalization costs.

Key words: Pyogenic liver abscess, Diabetes, Biliary tract disease, Therapy

张威, 陈国林, 王航, 余良, 孔祥璐. 合并不同基础疾病的细菌性肝脓肿患者临床特征分析[J]. 实用肝脏病杂志, 2023, 26(3): 424-427.

Zhang Wei, Chen Guolin, Wang Hang, et al.. Clinical feature of patients with pyogenic liver abscess with different underlying diseases[J]. Journal of Practical Hepatology, 2023, 26(3): 424-427.

参考文献

[1] Zimmermann L, Wendt S, Lübbert C, et al. Epidemiology of pyogenic liver abscesses in Germany: analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance. United European Gastroenterol J, 2021,9(9):1039-1047.
[2] Kumar SK, Perween N, Omar BJ, et al. Pyogenic liver abscess: clinical features and microbiological profiles in tertiary care center. J Family Med Prim Care,2020,9(8):4337-4342.
[3] 王雪梅,张瑶,杨学平,等.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.实用肝脏病杂志,2021,24(4):573-576.
[4] Lardière-Deguelte S, Ragot E, Amroun K, et al. Hepatic abscess: Diagnosis and management. J Visc Surg,2015,152(4):231-243.
[5] Song H, Wang X, Lian Y, et al. Analysis of the clinical characteristics of 202 patients with liver abscess associated with diabetes mellitus and biliary tract disease. J Int Med Res,2020,48(8):300060520949404.
[6] 张溥,李登科,孙文兵,等.高毒力肺炎克雷伯菌性肝脓肿的研究现状与进展.中华肝胆外科杂志,2020,26(12):949-953.
[7] Foo NP, Chen KT, Lin HJ, et al. Characteristics of pyogenic liver abscess patients with and without diabetes mellitus. Am J Gastroenterol,2010,105(2):328-335.
[8] Li W, Chen H, Wu S, et al. A comparison of pyogenic liver abscess in patients with or without diabetes: a retrospective study of 246 cases. BMC Gastroenterol, 2018,18(1):144.
[9] Lee CH, Jo HG, Cho EY, et al. Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess. BMC Infect Dis,2021,21(1):171.
[10] Jindal A, Pandey A, Sharma MK, et al. Management practices and predictors of outcome of liver abscess in adults: a series of 1630 patients from a liver unit. J Clin Exp Hepatol,2021,11(3):312-320.
[11] Du Z, Zhou X, Zhao J, et al. Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization. BMC Infect Dis,2020,20(1):145.
[12] Myeong JH, Kyoung DS, Park MA, et al. Anaerobe coverage is important for the prognosis of pyogenic liver abscess: a population-based study in Korea. J Infect Public Health,2022,15(4):425-432.
[13] Mukthinuthalapati VVPK, Attar BM, Parra-Rodriguez L, et al. Riskfactors, management, and outcomes of pyogenic liver abscess in a US safety net hospital. Dig Dis Sci,2020,65(5):1529-1538.
[14] Lee NK, Kim S, Lee JW, et al. CT differentiation of pyogenic liver abscesses caused byKlebsiella pneumoniae vs non-Klebsiella pneumoniae. Br J Radiol,2011, 84(1002):518-525.
[15] Lee HL, Lee HC, Guo HR, et al. Clinical significance and mechanism of gas formation of pyogenic liver abscess due to a Klebsiella pneumonie. J Clin Microbiol, 2004,42(6):2783-2785.
[16] Lai KC, Cheng KS, Jeng LB, et al. Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer. Am J Surg,2013,205(1):52-57.
[17] Miek T, Ciostek P. Percutaneous treatment of liver abscess – outcomes. Prz Gastroenterol,2019,14(2):129-132.
[18] 王思琪,申远,崔振兴,等.腹腔镜穿刺置管引流术与腹腔镜切开置管引流术治疗肝脓肿患者疗效观察.实用肝脏病杂志,2022,25(2):283-286.
[19] Gao HN, Yuan WX, Yang MF, et al. Clinical significance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess. World J Gastroenterol, 2010,16(38):4871-4875.
[20] 黎伟政,黄杰安.消化系统隐匿性恶性肿瘤相关化脓性肝脓肿的研究进展. 中华肝脏病杂志,2021,29(3):275-278.