糖尿病并发深部脓肿的危险因素及临床特点分析

Analysis of risk factors and clinical features of diabetic patients with deep abscess

目的探讨糖尿病合并深部脓肿的临床特点、危险因素,指导临床诊断、治疗及预防。方法回顾性分析32例糖尿病合并深部脓肿住院病例的临床特点、危险因素、感染部位、常见病原菌及药敏结果。结果该组病例以2型糖尿病为主(96.88%),62.50%以发热为首发症状,37.50%初次诊断糖尿病,年龄≥60岁、患者来源农村及乡镇、血糖控制差、低蛋白血症是糖尿病合并深部脓肿的危险因素。感染部位以肝最多见(68.75%),其次是肾及肾周(25.00%),常见病原菌为肺炎克雷伯菌及大肠埃希菌。结论有效控制血糖,改善营养状态以及提高患者对糖尿病认识对预防糖尿病合并深部脓肿是至关重要的。糖尿病合并深部脓肿者临床症状往往不典型,对不明原因发热的糖尿病患者要高度警惕深部脓肿,建议将腹部彩超和胸片作为糖尿病发热患者的常规筛查项目,培养结果回示之前可经验性选择针对革兰阴性菌敏感的抗生素。

Objective To investigate the clinical features and risk factors of diabetic patients with deep abscess in order to guide the clinical diagnosis,treatment and prevention of the disease. Methods The clinical features,risk factors,infection site,common pathogenic bacteria and drug sensitivity of 32 diabetic patients with deep abscess were retrospectively analyzed. Results Most of the patients were the type 2 diabetes（ 96. 88%）. The first symptom was fever that accounted for 62. 5%. 37. 5% of the patients were the first diagnosis of diabetes with age equal to or older than 60 years old. The patients came from rural area or small towns. The poor blood sugar control and hypoalbuminemia were risk factors for deep abscess in these patients. The most common sites of infection were liver（ 68. 75%） and the second was kidney and perirenal tissues. The common pathogens were Klebsiella pneumoniae and Escherichia coli.Conclusion It is very important to effectively control the blood sugar,improve the nutritional status and the knowledge of diabetes for preventing diabetic patients with deep abscess. The clinical symptoms of diabetic patients with deep abscess are often not typical. Therefore,it should be alert for deep abscess as diabetic patients with fever of unknown origin. The abdominal ultrasound and chest X-ray should be applied as a routine screening program for diabetes patients with fever. We may experimentally select the antibiotics sensitive to gram-negative bacteria before bacterial culture results.