糖尿病与非糖尿病并发肝脓肿临床特点的比较

COMPARISON OF CLINICAL FEATURES OF LIVER ABSCESS BETWEEN DIABETIC PATIENTS AND NON-DIABETIC PATIENTS

目的探讨糖尿病与非糖尿病病人并发肝脓肿临床特点的差异,为其诊断、治疗提供依据。方法回顾分析肝脓肿病人71例的临床资料,其中糖尿病并发肝脓肿组39例,非糖尿病肝脓肿组32例,比较两组临床表现、并发症、实验室检查、肝脓肿特点、治疗方法及预后等。结果两组年龄及性别差异无统计学意义(P>0.05),腹部压痛与叩痛比例差异有显著性(χ2=11.86,P<0.01),并发肺内感染比例差异有显著性(χ2=6.05,P<0.05)。穿刺脓液细菌培养多为肺炎克雷白杆菌亚种,两组比较差异无显著性(P>0.05)。实验室检查三酰甘油、尿素氮、空腹血糖两组间比较差异有显著性(t=2.15～6.83,P<0.05),糖尿病并发肝脓肿组空腹血糖与三酰甘油水平呈正相关(r=0.34,P<0.01)。两组治疗及预后差异无显著性(P>0.05)。结论糖尿病并发肝脓肿病人症状体征不明显,容易漏诊误诊,且易并发其他部位的感染,病原菌以肺炎克雷白杆菌亚种多见,治疗宜及时采取个体化和综合措施。

Objective To analyze the differences of clinical manifestations of liver abscess between diabetic and non-diabetic patients,and provide evidence for its diagnosis and therapy.Methods A retrospective analysis of clinical data of 71 patients with liver abscess,of those,39 cases were occurred in diabetics,and 32 were seen in non-diabetic patients.The clinical manifestations,complications,laboratory examination,features of liver abscess,therapy,and prognosis between the two groups were compared.Results A comparison between the two groups showed no age and sex differences（P0.05）;the ratio of abdominal tenderness and sensitive to percussion was different（χ2=11.86,P0.01）;and the difference of the ratio of lung infections was significant as well（χ2=6.05,P0.05）.Klebsiella pneumoniae（Kp） subspecies was mostly seen in stab culture of the pus,the differences between the two groups were not significant（P0.05）.Laboratory examination： the differences of triglycerides（TG）,urea nitrogen（BUN）,and fasting blood sugar（FBG） between the two groups were significant（t=2.15-6.83,P0.05）.In diabetics with liver abscess,FBG was positively correlated with TG（r=0.34,P0.01）.No significant differences were noted between the two groups in terms of therapy and prognosis（P0.05）.Conclusion There are no obvious symptoms and signs in diabetes complicated by liver abscess,which easily result in missed diagnosis and diagnostic errors.Coinfections of other parts of the body are common,mostly caused by Klebsiella pneumoniae subspecies.A prompt,individualized,and combined moda-lity therapy should be carried out for this condition.