细菌性肝脓肿合并糖尿病患者的临床特征分析

Analysis of clinical characteristics of pyogenic liver abscess patients with diabetes mellitus

目的分析细菌性肝脓肿(PLA)合并糖尿病患者临床特点,以期指导临床诊断与治疗。方法选取重庆医科大学附属第一医院2015年1月—2019年12月收治的PLA患者225例,按是否患糖尿病分为糖尿病组(109例)和非糖尿病组(116例)。回顾性分析两组患者的一般资料、临床表现、实验室检查、病原学情况、并发症、治疗及预后。结果糖尿病组患者平均年龄大于非糖尿病组(P<0.05)。糖尿病组合并高血压、脑梗死的概率高于非糖尿病组(P<0.05)。糖尿病组出现发热、乏力概率高于非糖尿病组(P<0.05),前白蛋白水平低于非糖尿病组(P<0.05),余腹胀、腹痛、呕吐、寒战、腹部压痛、肝区叩痛、白细胞计数、中性粒细胞百分比、血红蛋白、血小板计数、白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、活化部分凝血活酶时间、凝血酶原时间、血尿素氮、血肌酐、降钙素原比较,差异均无统计学意义(均P>0.05)。糖尿病组总阴性菌及肺炎克雷伯菌(KP)感染率高于非糖尿病组,米勒链球菌群感染率低于非糖尿病组(P<0.05)。糖尿病组合并肺炎、脓毒血症、感染性休克占比高于非糖尿病组(P<0.05),抗生素使用情况及预后比较,差异无统计学意义(P>0.05)。结论PLA合并糖尿病好发于中老年男性,临床表现不典型,易合并KP感染,更容易出现肺炎、脓毒血症、感染性休克等并发症。

Objective To analyze the clinical characteristics of pyogenic liver abscess(PLA)patients with diabetes mellitus in order to guide the clinical diagnosis and treatment.Methods A total of 225 patients with PLA treated in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019 were selected,they were divided into diabetic group(109 cases)and non-diabetic group(116 cases)according to whether they had diabetes or not.The general data,basic diseases,clinical manifestation,laboratory findings,pathogenic results,complications,treatment and prognosis of the two groups were analyzed retrospectively.Results The mean age of diabetic group was higher than that of non-diabetic group(P<0.05).The probability of hypertension and cerebral infarction in diabetic group was higher than that in non-diabetic group(P<0.05).The probability of fever and fatigue in diabetic group was higher than that in non-diabetic group(P<0.05),and the prealbumin level was lower than that in non-diabetic group(P<0.05).Abdominal distension,abdominal pain,vomiting,chills and abdominal tenderness,tap pain,white blood cell count,liver area percentage granulocyte,hemoglobin,platelet count,albumin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,activated clotting time live enzymes,prothrombin time,blood urea nitrogen,serum creatinine,calcitonin original differences between groups were no statistical significance(all P>0.05).The infection rate of total negative bacteria and Klebsiella Pneumoniae(KP)in diabetic group was higher than that in non-diabetic group,and the infection rate of streptococcus mueller group was lower than that in non-diabetic group(P<0.05).The proportion of pneumonia,sepsis and septic shock in DM group was higher than that in non-diabetic group(P<0.05),and there was no significant difference in antibiotic use and prognosis between the two groups(P>0.05).Conclusion PLA complicated with diabetes is common in middle-aged and elderly men with atypical clinical manifestations,easy to be complicated with KP infection,and more prone to complications such as pneumonia,sepsis,septic shock.