不同糖化血红蛋白水平的糖尿病患者合并细菌性肝脓肿的临床特征分析

Clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin

目的探讨不同糖化血红蛋白(HbAlc)水平的糖尿病患者合并细菌性肝脓肿的临床特征。方法纳入2014年12月-2018年12月入住江苏省苏北人民医院的118例成年糖尿病合并细菌性肝脓肿患者,按照不同HbAlc水平分成3组,即良好组(n=32)、一般组(n=31)、较差组(n=55),比较分析3组的一般资料、临床表现、检验检查结果、并发症和病原学检查。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ^2检验或Fisher确切概率法。结果不同HbAlc水平患者相比较,3组间平均年龄、住院时长组间差异均有统计学意义(F值分别为2.933、3.310,P值分别为0.016、0.044),HbAlc水平较差组较控制良好组平均发病年龄低,且住院时长更长(P值均<0.05)。糖尿病合并肝脓肿基础疾病占比排在第一位的是高血压,其次为胆道疾病,再次为脑梗死,3组患者基础疾病在脑梗死方面差异有统计学意义(χ^2=6.135,P=0.037)。较差组与其他两组比较腹部压痛体征少,不典型(χ^2=6.178,P=0.046),较差组CRP较其他两组更易升高(χ^2=5.985,P=0.049),更易发生脓毒血症(χ^2=6.247,P=0.044)。结论当糖尿病患者合并细菌性肝脓肿时,HbAlc水平不佳者年龄在发病人群中偏低,住院时间更长,临床体征不典型,易发生脓毒血症,因此,可能导致临床关注度不足,延误诊治,甚至危及生命,应引起警惕。

Objective To investigate the clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin(HbAlc).Methods A total of 118 adult diabetic patients with bacterial liver abscess who were admitted to our hospital from December 2014 to December 2018 were enrolled,and according to the level of HbAlc,they were divided into well-controlled group with 32 patients,fairly-controlled group with 31 patients,and poorly-controlled group with 55 patients.The three groups were compared in terms of general data,clinical manifestations,laboratory results,complications,and pathogen test results.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.Results There were significant differences in mean age and length of hospital stay between the three groups(F=2.933 and 3.310,both P<0.05).Compared with the other two groups,the poorly-controlled group had a significantly younger mean age of onset(P=0.016)and a significantly longer length of hospital stay(P=0.044).Hypertension was the most common underlying disease in diabetic patients with liver abscess,followed by biliary tract diseases and cerebral infarction,and there was a significant difference in cerebral infarction between the three groups(χ^2=6.135,P=0.037).Compared with the well-controlled group,the poorly-controlled group had significantly fewer and less typical signs of abdominal tenderness(χ^2=6.178,P=0.046),and compared with the other two groups,the poorly-controlled group tended to have a significant increase in C-reactive protein(χ^2=5.985,P=0.049)and were more likely to develop sepsis(χ^2=6.247,P=0.044).Conclusion For diabetic patients with bacterial liver abscess,the patients with a poorly controlled HbAlc level often have a young age of onset,a long length of hospital stay,and atypical clinical signs and are likely to develop sepsis,which may lead to insufficient attention in clinical practice,delay diagnosis and treatment,and even endanger life,and therefore,such patients should be taken seriously in clinical practice.