肺炎克雷伯菌肝脓肿与非肺炎克雷伯菌肝脓肿的特征比较研究

Comparative study of characteristics of Klebsiella pneumoniae liver abscess and non-Klebsiella pneumoniae liver abscess

目的分析肺炎克雷伯菌肝脓肿(KPLA)的临床和实验室检查指标特征,为其诊断和治疗提供依据。方法选取该院2016年1月至2020年12月收治的215例肝脓肿患者,根据病原学检测结果分为肺炎克雷伯菌肝脓肿组(KPLA组)和非肺炎克雷伯菌肝脓肿组(NKPLA组)。比较两组的临床特征、实验室检查指标、治疗方法及患者的预后情况。结果215例肝脓肿患者中细菌培养结果阳性98例,其中72例(73.47%)为肺炎克雷伯菌。KPLA组患者分离的肺炎克雷伯菌对除氨苄西林外的大部分抗菌药物敏感。KPLA组合并糖尿病的比例高于NKPLA组(P<0.05),合并胆道疾病的比例低于NKPLA组(P<0.05),两组治疗时间、治疗方法、治疗效果比较,差异无统计学意义(P>0.05)。KPLA组天门冬氨酸氨基转移酶(AST)、血红蛋白、葡萄糖(GLU)水平高于NKPLA组(P<0.05)。KPLA患者中,合并糖尿病患者比未合并糖尿病患者治疗时间明显延长(P<0.05),白细胞计数、中性粒细胞绝对值、GLU水平显著升高(P<0.05),AST水平显著降低(P<0.05);KPLA合并胆道疾病患者比未合并胆道疾病患者治疗好转比例低(P<0.05),血小板计数及γ-谷氨酰转肽酶水平显著升高(P<0.05)。而合并胃肠道疾病患者与未合并胃肠道疾病患者间临床特征和实验室指标比较,差异无统计学意义(P>0.05)。结论肺炎克雷伯菌是细菌性肝脓肿的主要致病菌,KPLA患者合并糖尿病比例高于NKPLA患者,且炎症指标水平升高,治疗时间长,KPLA合并胆道疾病患者治疗好转比例低于未合并胆道疾病患者,应早期合理应用抗菌药物治疗。

Objective To analyze the characteristics of clinical and laboratory detection indicators in Klebsiella pneumoniae liver abscess(KPLA)to provide the evidence for its diagnosis and treatment.Methods A total of 215 patients with liver abscess admitted to this hospital from January 2016 to December 2020 were selected and divided into the Klebsiella pneumoniae group(KPLA group)and non-Klebsiella pneumoniae group(NKPLA group)according to the etiological results.The clinical characteristics,laboratory detection indicators,treatment methods and prognosis of the patients were compared between the two groups.Results Among 215 cases of liver abscess,98 cases were positive for bacterial culture,in which 72 cases(73.47%)were cultured as Klebsiella pneumonia.Klebsiella pneumoniae isolated from the patients in the KPLA group was sensitive to most antibacterial drugs except for ampicillin.The proportion of complicating diabetes in the KPLA group was higher than that in the NKPLA group(P<0.05),and the proportion of complicating biliary tract diseases in the KPLA group was lower than that in the NKPLA group(P<0.05).There was no statistically significant difference in treatment time,treatment methods and treatment results between the two groups.The levels of aspartate transaminase(AST),hemoglobin and glucose(GLU)in the KPLA group were higher than those in the NKPLA group(P<0.05).Among the patients with KPLA,the treatment time in the patients with complicating diabetes was significantly prolonged compared with that in the patients without complicating diabetes(P<0.05),the WBC count,neutrophil absolute count and GLU level were significantly increased(P<0.05),and the AST level was significantly decreased(P<0.05).The proportion of treatment improvement in the patients with complicating biliary tract diseases was lower than that in the patients without complicating biliary tract diseases,and the platelet count andγ-glutamyl transpeptidase(GGT)levels were significantly increased(P<0.05).However,there was no statistically significant difference in clinical features and laboratory indexes among KPLA patients with or without gastrointestinal diseases.Conclusion Klebsiella pneumoniae is the main pathogen of bacterial liver abscess.The proportion of complicating diabetes in KPLA patients is higher than that in the patients with NKPLA,moreover the levels of inflammatory indicators are increased and treatment time is long,and the improvement proportion of the patients with KPLA complicating biliary diseases is lower than that in the patients without complicating biliary diseases,they should early and rationally use the antibacterial drugs.