不同糖化血红蛋白控制水平糖尿病并发肺炎克雷伯杆菌肝脓肿患者的临床和影像学表现

Clinical and Imaging Features of Patients With Bacterial Liver Abscess Caused by Klebsiella Pneumoniae in Diabetics at Different Levels of Glycosylated Hemoglobin Control

目的探讨不同糖化血红蛋白(HbA_(1c))控制水平糖尿病并发肺炎克雷伯杆菌肝脓肿(KPLA)患者的临床和影像学表现。方法选取2008年1月—2015年9月南京医科大学附属无锡人民医院收治的146例糖尿病并发KPLA患者,根据HbA_(1c)水平分成3组:A组31例,HbA_(1c)水平控制好,HbA_(1c)≤7.0%;B组52例,HbA_(1c)水平控制较好,7.0%<HbA_(1c)≤9.0%;C组63例,HbA_(1c)水平控制差,HbA_(1c)>9.0%。收集并比较3组患者基本资料、基础疾病、症状和体征、穿刺引流术前影像学表现、并发症、脓肿转移、治疗及预后情况。结果 B组患者住院时间较A组延长(P<0.05);C组患者年龄较A组和B组小、住院时间较A组和B组延长(P<0.05)。B组患者高脂血症、慢性肾功能不全、超声检查胆管系统积气、CT检查脓腔内积气及胸膜增厚、胸腔积液发生率较A组升高,C组患者高脂血症、慢性肾功能不全、超声检查胆管系统积气、CT检查脓腔内积气及胸膜增厚、胸腔积液、膈下脓肿发生率较A组和B组升高(P<0.01)。患者入院后均采用超声引导定位下肝脓肿穿刺引流,C组患者1例因全身多发感染并发多器官衰竭死亡,其余患者均恢复出院。结论糖尿病并发KPLA患者HbA_(1c)水平控制差者年龄偏小、住院时间较长,高脂血症、慢性肾功能不全发生率高,超声检查胆管系统积气、CT检查脓腔内积气、胸膜增厚发生率高,胸腔积液和膈下脓肿发生率较高,重症者可发生死亡,临床治疗中应警惕此类患者,预防不良预后。

Objective To discuss the clinical and imaging features of patients with bacterial liver abscess caused by Klebsiella pneumoniae liver abscesses（ KPLA） in diabetics at different levels of glycosylated hemoglobin（ HbA_（1c）） control.Methods A total of 146 patients with diabetes combined with KPLA admitted in Wuxi People＇ s Hospital of Nanjing Medical University from January 2008 to September 2015 were selected. According to the levels of Hb A1 c,they were divided into three groups,namely group A including 31 patients with good control of Hb A1 clevel,HbA_（1c）≤ 7. 0%; group B including 52 patients with relatively control of Hb A1 clevel,7. 0% HbA_（1c）≤ 9. 0%; and group C including 63 patients with poor control of Hb A1 c level,HbA_（1c） 9. 0%. The basic information, underlying diseases, signs and symptoms, imaging features before abscess drainage,complications,abscess metastasis,treatment and prognosis of the patients in 3 groups were collected and compared.Results The time of hospital stay of patients in group B was longer than that in group A（ P〈0. 05）. The age of patients in group C was younger than that in group A and group B,the time of hospital stay of patients in group C was longer than that in group A and group B（ P〈0. 05）. The incidence of hyperlipidaemia,chronic renal failure,pneumatosis of biliary system by ultrasonic,pneumatosis of vomica exaimined and pleural thickening by CT,pleural effusion of patients in group B were higher than those in group A（ P〈0. 01）. The incidence of hyperlipidaemia,chronic renal failure,pneumatosis of biliary system by ultrasonic,pneumatosis of vomica exaimined and pleural thickening by CT,pleural effusion,subphrenic abscesses of patients in group C were higher than those in group A and group B（ P〈0. 01）. All patients received the ultrasound guided percutaneous catheter drainage for liver abscess after their admission. One case of patient in group C died of systemic multiple infection complicated by organ failure. The rest patients had recovered and been discharged from hospital. Conclusion Patients with diabetes complicated by KPLA and with poor control of Hb A1 clevel have young and longer time in hospitalization, higher incidence of hyperlipemia and chronic renal failure. The imaging features shows the high incidence of pneumatosis of biliary system by ultrasonic,pneumatosis of vomica exaimined and pleural thickening by CT,as well as higher incidence of pleural effusion,subphrenic abscesses. Patients with severe illness may die and they should be thought highly of and prevented from diseases with poor prognosis.