137例细菌性肝脓肿患者的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of 137 patients with pyogenic liver abscess

目的探讨细菌性肝脓肿(PLA)的临床特征、危险因素,为PLA的早期诊疗提供参考。方法回顾性分析2017年1月至2021年10月于广西医科大学第二附属医院收治的137例细菌性肝脓肿患者的临床资料,根据合并糖尿病情况将患者分为糖尿病组(58例)和非糖尿病组(79例),比较两组临床特征、病原学特点、实验室指标和影像学特征的差异及影响患者预后的危险因素。结果(1)一般资料:糖尿病组与非糖尿病组的年龄、平均住院天数差异均有统计学意义(P<0.05);两组在基础疾病中差异有统计学意义(P<0.05),合并糖尿病组的基础疾病主要是胆道疾病(20.69%)、高血压(36.21%),非合并糖尿病组的基础疾病主要是胆道疾病(15.19%)、胆道手术史(18.99%)。(2)临床表现:两组在临床表现方面无统计学意义(P>0.05),均以发热、腹痛、腹胀人数占比高。(3)病原学结果:共检出病原菌39例(26.62%),其中肺炎克雷伯菌22例,大肠埃希菌10例。(4)影像学结果:两组在单个、多个脓肿数量差异无统计学意义(P>0.05),肝脓肿的分布部位差异无统计学意义(P>0.05),以单个脓肿为主,102例(74.45%);分布以右叶为主,95例(69.34%)。(5)治疗方法及预后:两组采用单纯抗生素、抗生素+穿刺引流及抗生素+穿刺引流+手术三种治疗方法的差异无统计学意义(P>0.05),治疗效果差异无统计学意义(P>0.05),其中治疗方法以单纯抗生素、抗生素+穿刺引流为主。(6)实验室检查:两组PT及总胆红素水平差异有统计学意义(P<0.05),而WBC、Hb、PLT、中性粒细胞绝对值、中性粒细胞百分比、HCT、APTT、白蛋白、ALT、AST、尿酸组间比较差异无统计学意义(P>0.05)。结论合并糖尿病的细菌性肝脓肿患者临床表现往往更不典型,应将高龄、凝血功能异常的患者纳入早期识别人群,避免误诊及漏诊,及早针对性治疗,降低并发症风险。

Objective To investigate the clinical features and risk factors of pyogenic liver abscess(PLA),so as to provide reference for the early diagnosis and treatment of PLA.Methods The clinical data of 137 patients with PLA in the Second Affiliated Hospital of Guangxi Medical University from January 2017 to October 2021 were retrospectively analyzed,and the patients were divided into diabetic group(58 cases)and non-diabetic group(79 cases)according to the presence of diabetes.The differences in clinical characteristics,etiological characteristics,laboratory indexes,and imaging characteristics as well as the risk factors affecting the prognosis of patients were compared between the two groups.Results(1)General data:there was statistically significant differences in age and average length of hospital stay between the diabetic group and the non-diabetic group(P<0.05).The difference in underlying diseases between the two groups was statistically significant(P<0.05);the underlying diseases in the diabetic group were mainly biliary diseases(20.69%)and hypertension(36.21%),and those in the non-diabetic group were mainly biliary diseases(15.19%)and biliary surgery history(18.99%).(2)Clinical symptoms:there was no statistically significant difference in clinical symptoms between the two groups(P>0.05),with fever,abdominal pain and abdominal distension accounted for a high proportion of symptoms in both groups.(3)Etiological results:39 cases(26.62%)were detected with pathogenic bacteria,among which were 22 cases of Klebsiella pneumoniae and 10 cases of Escherichia coli.(4)Imaging results:there were no statistically significant differences in the number of single and multiple abscesses between the two groups(P>0.05),there were no statistically significant differences in the distribution of liver abscesses(P>0.05),and 102 cases(74.45%)were single abscess,and 95 cases(69.34%)were mainly distributed in the right lobe.(5)Treatment methods and prognosis:there were no statistically significant differences in the three treatment methods of antibiotics alone,antibiotics+puncture drainage,and antibiotics+puncture drainage+surgery between the two groups(P>0.05)and in the treatment effects(P>0.05),among them,the treatment methods were mainly antibiotics,antibiotics+puncture drainage.(6)Laboratory examination:there were statistically significant differences in the levels of PT and total bilirubin between the two groups(P<0.05),but no statistically significant differences in WBC,Hb,PLT,neutrophils absolute value,neutrophils percentage,HCT,APTT,albumin,ALT,AST,and uric acid between the two groups(P>0.05).Conclusion The clinical symptoms of PLA patients with diabetes are usually more atypical.Patients with advanced age and abnormal coagulation function should be included in the early identification population to avoid misdiagnosis and missed diagnosis,and targeted treatments should be implemented early to reduce the risk of complications.