71例肝脓肿临床及病原学特点分析

Clinical and bacteriological analysis of 71 cases with pyogenic liver abscess

目的分析肝脓肿的临床基线及病原学特征,旨在提高临床对该病早期识别、病原体预判、并发症警惕及抗感染治疗能力。方法收集广州番禺区中心医院2019年1月-2020年11月收治的肝脓肿病例相关临床及实验室资料。按病原体培养结果分成阳性组、阴性组。阳性组中,按不同致病菌分成肺炎克雷伯及非肺炎克雷伯亚组。比较不同组别间基线特征及实验室数据。结果共收集肝脓肿71例,病原学培养阳性率83.1%(59例),其中肺炎克雷伯菌46例(80%)。最常见合并症包括糖尿病(54.9%)、胆道疾病(56.3%)、肺部感染(67.6%)等。病原体阳性组PCT和AST水平高于阴性组(P<0.05),但是两组之间基线特征无差异(P>0.05)。肺炎克雷伯亚组与其他病原体组相比,合并糖尿病的风险更高(P=0.007),PLT、PCT、ALT、AST和白蛋白的水平具有显著差异(P<0.05)。经过积极治疗,大多预后良好,未见死亡病例,其中7例患者发生严重侵袭性脓肿,遗留后遗症。结论病原体阴性肝脓肿致病力方面与阳性组并无差别。肺炎克雷伯杆菌已成为肝脓肿中最常见菌群,其多见于合并糖尿病患者。其PLT、PCT、ALT、AST指标明显高于其他菌群组,伴白蛋白消耗明显。少数可伴有全身严重侵袭性脓肿。

Objective To investigate the clinical and etiological characteristics of pyogenic liver abscess(PLA)as a reference for its early identification,early prediction of pathogens,alertness to complications and rational antibacterial treatment.Methods A single center retrospective study was carried out in patients with PLA in Guangzhou Panyu Center Hospital from January 2019 to November 2020.The clinical and laboratory data of all liver abscess cases were concluded.Baseline characteristic and laboratory outcomes were grouped into Klebsiella pneumoniae group and non-Klebsiella pneumoniae subgroup according to different pathogenic bacteria.Results Among a total of 71 patients with liver abscess,83.1%(n=59)had positive cultures.Klebsiella pneumoniae accounted for the most in 46 cases(80.0%).The most common complications included diabetes(50.7%),biliary tract disease(56.3%),pulmonary infection(67.6%)etc.The levels of PCT and AST in pathogen culture-positive group were higher than those in culture-negative group,with statistical significance(P<0.05),on the contrary there were no differences in baseline characteristic among the groups according to the results of pathogens.Compared with other pathogens,the group of Klebsiella pneumoniae liver abscess presented higher risk of diabetes.The levels of PLT,PCT,ALT,AST,and albumin in the two groups were different(P<0.05).Most patients had good outcomes,while 7 patients had residual problems represented with severe invasive abscess.Conclusion There were similar consequences between negative and positive liver abscesses.Klebsiella pneumoniae has become the most common bacteria in liver abscess.Among which,PLT、PCT、ALT、AST indexes are higher than that of other bacteria with obvious albumin depletion,even some of which may be accompanied by systemic severe invasive abscess.