目的 探讨221例肝脓肿患者的临床特点和病原学分类。方法 回顾性收集新疆维吾尔自治区人民医院 2015-01至2020-01收治的221例肝脓肿患者的临床和微生物学资料,将肝脓肿分为肺炎克雷伯组和非肺炎克雷伯组,分析比较两组基础疾病、临床表现及并发症,并采用logistic回归分析危险因素。结果 189例行经皮肝脓肿穿刺引流联合药物治疗;9例行经皮肝脓肿穿刺引流联合药物治疗效果不佳后,再次行腹腔镜下肝脓肿切除;23例行单纯药物治疗。全部病例中,肝脓肿脓液细菌培养明确为肺炎克雷伯菌90例(肺炎克雷伯菌组),其他细菌培养阳性50例(非肺炎克雷伯菌组),未检测病例和阴性81例。肺炎克雷伯组与非肺炎克雷伯组对比,肺炎克雷伯组糖尿病、嗜酒习惯的比例更高,直径在5~10 cm的肝脓肿更多见,药物联合经皮穿刺引流治疗的比例更高,发生感染性休克的比例更高(P＜0.05)。糖尿病和嗜酒是肺炎克雷伯肝脓肿的危险因素。结论 肺炎克雷伯菌是细菌性肝脓肿的主要致病菌,糖尿病和嗜酒是其危险因素,须早期外科干预联合药物治疗。
Abstract
Objective To explore the clinical characteristics and pathogenic classification of 221 cases of patients with pyogenic liver abscess in Xinjiang Uygur Autonomous Region People’s Hospital.Methods The clinical data and microbiological data of 221 cases of patients with pyogenic liver abscess from January 2015 to January 2020 were collected retrospectively. After analysis of general information of 221 cases of patients with pyogenic liver abscess, the Chi-square test or Fisher test was used for comparison of clinical data between Klebsiella pneumoniae strains group and non-Klebsiella pneumoniae strains group; the logistic regression analysis was used for analyze risk factors for liver abscess caused by Klebsiella pneumoniae.Results Percutaneous drainage and drugs were performed in 189 cases of patients, laparoscopic resection of liver abscess following the percutaneous drainage and drugs due to the failure in 9 cases of patients, drugs alone in 23 cases of patients. Compared with non-Klebsiella pneumoniae strains group, the percentage of diabetes and alcoholism, treatment with drugs and percutaneous drainage, septic shock and the liver abscess in 5-10 cm in the diameter were higher in Klebsiella pneumoniae strains. Diabetes and alcoholism were the risk factors of liver abscess caused by Klebsiella pneumoniae strains.Conclusions Klebsiella pneumoniae strains is main pathogenic bacteria of pyogenic liver abscess, and diabetes and alcoholism are the risk factors of Klebsiella pneumoniae liver abscess, which shows more severe invasiveness and difficult treatment.
关键词
肝脓肿 /
临床特征 /
肺炎克雷伯菌
Key words
liver abscess /
clinical characteristics /
Klebsiella pneumoniae
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基金
新疆维吾尔自治区自然科学基金面上项目(2018D01C131)
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