高毒力肺炎克雷伯菌性肝脓肿的研究现状与进展

Research status and development of pyogenic liver abscess caused by hypervirulent Klebsiella pneumonia

细菌性肝脓肿是临床常见的危急重症,近年来,其致病菌谱已由过去的以大肠杆菌为主转变为以肺炎克雷伯菌,尤其是高毒力肺炎克雷伯菌为主。肝脓肿的临床特征、疾病转归以及治疗手段等亦有所改变。基于此,本文总结分析了近年来高毒力肺炎克雷伯菌性肝脓肿新的特点和变化,着重分析了该病个体化治疗方案的选择,尤其指出针对药物治疗和介入治疗效果不佳而需要行外科手术的患者,射频消融有可能成为一种新的安全有效的微创治疗手段。

Pyogenic liver abscess(PLA)is a common and critical disease in clinic.In recent years,its pathogenical bacteria spectrum has changed from Escherichia coli to Klebsiella pneumoniae especially hypervirulent Klebsiella pneumoniae(hvKp)is recognized as the predominant bacteria responsible for PLA at present.The clinical manifestations,imaging features,prognosis and treatment have also changed accordingly.Based on the above changes,our review summarized the virulence and pathogenic characteristics of hvKp.Diabetes mellitus is a major risk factor for pyogenic liver abscess caused by hvKp.Endophthalmitis and meningitis are metastatic complications with poor prognosis,which are more common in people with poor glycemic control.Single,solid and multilocular is identified as the main CT appearance of pyogenic liver abscess caused by hvKp.Individualized treatment regimens should be considered for different patients.It may depend on the location,size,amount and imaging features of the lesions.Radiofrequency ablation(RFA)is particularly put forward as an alternative therapeutic for patients who received drug and intervention treatment ineffectively and need surgery.RFA may become a new kind of safe and effective minimally invasive treatment.