肺炎克雷伯菌致肝脓肿侵袭综合征3例临床分析及文献复习

Clinical analysis of three cases of liver abscess invasion syndrome caused by Klebsiella pneumoniae infection

为提高对肺炎克雷伯菌感染所致肝脓肿侵袭综合征的临床表现及其危害的认识,回顾性分析3例确诊为肺炎克雷伯菌感染所致肝脓肿患者的临床经过、治疗反应及转归。结果发现3例患者均有肝外播散性病灶,符合肝脓肿侵袭综合征的临床特征。这3例患者为社区获得性感染,均有肝脓肿,其中2例合并眼内炎并造成失明,1例合并腰椎感染、腹主动脉感染及感染性心内膜炎。2例有糖尿病病史,1例免疫正常。结合文献复习,发现肺炎克雷伯菌感染引起肝脓肿及肝外播散性病灶,临床上称为肝脓肿侵袭综合征,大多由高毒力肺炎克雷伯菌引起,好发于糖尿病及免疫缺陷人群,也可发生于免疫正常人群,治疗困难,临床危害严重,需引起重视。

To improve the understanding of the clinical manifestations and dangers of liver abscess invasive syndrome caused by Klebsiella pneumoniae （K. pneumoniae） infection, the clinical courses, including treatment and outcomes of three cases were retrospectively analyzed. All infections were communityacquired. Their clinical manifestations and blood culture test results were in line with the clinical features of liver abscess invasive syndrome caused by K. pneumoniae infection. All had liver abscesses; two cases had complications with endophthalmitis leading to blindness; one patient was complicated with lumbar and abdominal aortic infection and infectious endocarditis. Two patients had diabetes history, and one patient was normal immunocompetent. The liver abscess invasive syndrome caused by K. pneumoniae infection should get more clinical attentions because it is hard to treat and may cause serious clinical dangers, not only liver abscess but also extrahepatic disseminated lesions. It is detected not only in diabetic and immunodeficient populations but also in the normal immunocompetent population.