隐源性肝脓肿和胆源性肝脓肿的临床对比分析

Clinical comparison between biliary and cryptogenic origin pyogenic liver abscesses

目的总结分析隐源性肝脓肿(pyogenic liver abscess,PLA)和胆源性PLA的临床特征差异,为临床诊治隐源性PLA提供依据。方法回顾性分析我院2001-07～2010-06收治的61例PLA临床资料,根据病因分为隐源性组36例,胆源性组25例,对比分析两组的临床资料。结果隐源性PLA多合并糖尿病,胆源性PLA多合并胆道结石,差异有统计学意义(P<0.05);畏寒/发热、白细胞计数升高、CRP升高和单个脓肿在隐源性组高于胆源性组,腹痛、黄疸、AKP升高和多个脓肿在胆源性组高于隐源性组,差异均有统计学意义(P<0.05)。隐源性组血培养阳性率高于胆源性组,隐源性组克雷伯氏菌培养阳性率高于胆源性组,胆源性组大肠埃希氏菌培养阳性率高于隐源性组,两组间比较差异均有统计学意义(P<0.05)。结论与胆源性PLA相比,隐源性PLA伴发糖尿病比例高,大多出现畏寒/发热,白细胞计数和CRP升高明显,多为单发,血培养阳性率较高,主要致病菌为克雷伯氏菌。

Objective To analyze the clinical features of biliary origin pyogenic liver abscesses （PLA） and cryptogenic origin PLA, and provide the evidence for diagnosis and treatment in cryptogenic origin PLA. Methods Clinical data of 61 cases with pyogenic liver abscesses from July 2001 to June 2010 were reviewed retrospectively. According to aetiology, all cases were divided into the biliary group （ n = 25） and cryptogenic group （n = 36）. Results Cryptogenic group had a higher frequency of underlying diabetes, and biliary group had a higher frequency of underlying bile duct stones, there was significant difference between two groups （ P 〈 0.05 ） ; Fever/chill, white blood cell increased,CRP increased and single abscess were more often presented in the cryptogenic group than in the biliary group, abdominal pain ,jaundice,AKP increased and multiple abscesses were more often presented in the biliary group than in the cryptogenic group, there were significant difference （P 〈 0. 05） ; There was a higher fequency of positive blood cultures in the cryptogenic group than in the biliary group,K, pneumoniae were more frequently isolated in the cryptogenic group, E. coli were more frequently isolated in the biliary group, there were significant difference （P 〈 0. 05）. Conclusion Compared to those patients with PLA of biliary origin, patients with PLA of cryptogenic origin had a higher frequency of underlying diabetes, fever/chill, white blood cell increased, CRP increased and single abscess were more often presented, there was a higher fequency of positive blood cultures, and K. pneumoniae were more frequently isolated in the cryptogenic group.