2型糖尿病患者合并肺炎克雷伯菌败血症的临床分析

Clinical study of Klebsiella bacteraemia in type 2 diabetic patients

目的对糖尿病(diabetes mellitus,DM)和非DM患者合并肺炎克雷伯菌败血症的临床特征及抗生素药敏结果资料进行回顾性分析,以便为2型糖尿病(type 2diabetes mellitus,T2DM)合并肺炎克雷伯菌败血症治疗提供理论依据。方法收集2010年1月至2016年1月西安交通大学第一附属医院和榆林市第一医院细菌培养室记录,确定肺炎克雷伯菌败血症的患者92例,其中DM患者46例,非DM患者46例,并对他们的临床资料及药敏结果进行分析。结果两组病例都多见于社区感染,但DM组社区感染比例更高(82.6%vs.63%,P<0.05);DM组更易合并胆道疾病(54.3%vs.26.1%,P<0.05)、脂肪肝(15.2%vs.2.17%,P<0.05)、慢性肾功能不全(21.7%vs.2.17%,P<0.05);非DM组更易合并肿瘤(23.9%vs.45.6%,P<0.05)。DM组临床表现较非DM组体温升得更高(39.1±0.8vs.38.6±0.9,P<0.05),且寒战(78.3%vs.43.5%,P<0.01)、休克(15.2%vs.2.17%,P<0.05)常见。DM组更易形成脓肿(84.7%vs.21.7%,P<0.01),尤其是肝脓肿(23.9%vs.13.0%,P<0.05)、肺脓肿(10.8%vs.0%,P<0.05)、眼内炎(10.8%vs.0%,P<0.05)发生率较高。DM组与非DM组在抗菌素敏感率方面无明显差异,对碳青霉烯类、头孢菌素三代、四代、喹诺酮有较高的敏感性;抗菌素耐药率由高到低依次为氨苄西林、头孢菌素一代、二代、氨基糖甙类、氨曲南、磺胺类、硝基呋喃类,庆大霉素耐药率在两组之间差异有统计学意义(43.5%vs.13.0%,P<0.01)。结论 T2DM合并肺炎克雷伯菌败血症临床表现较重,更易形成脓肿和转移性感染,死亡率较高。及时选择合理的抗生素和脓肿引流对预后至关重要。

Objective To summarize the clinical features of essential tremor （ET） so as to provide evidence for both its clinical and differential diagnosis. Methods All patients with definite ET from the First Affiliated Hospital of Xi’an Jiaotong University from July 2010 to February 2013 were enrolled in the study. We collected all their information including general condition, tremor type, tremor scale and tremor grade. Results There were 145 ET patients enrolled in this study. The single peak of onset age was between the forties and fifties, with male and female ones having the same prevalence. Tremor was the most common in upper limbs （88.96%）, followed by head （39.31%）, lower limbs （13.10%）, jaw and tongue （10.34%）, and trunk （2.76%）. Tremor type was mainly isolated postural tremor （63.44%）, followed by mixed type （35.17%） and isolated action tremor （1.39%）. Those patients with upper limbs tremor experienced much more possibility of tremor spreading to other sites. And those with older age of onset showed more rapid progression. There was no difference in clinic features between familial ET and sporadic ET. Conclusion The onset anatomic distribution and age are related to the progression of ET. Genetic factor may not be the primary factor in the etiology of ET.