细菌性肝脓肿合并糖尿病患者的临床表现特点

Clinical characteristics of bacterial liver abscess in diabetic patients

目的分析细菌性肝脓肿(BLA)合并糖尿病患者的临床表现、实验室及影像学检查资料,为临床诊疗提供参考。方法收集2017年1月至2022年12月中国科学院大学深圳医院收治的62例BLA患者的临床资料,比较BLA合并与不合并糖尿病患者的临床特征。结果62例BLA患者中,合并糖尿病28例(合并组),不合并糖尿病34例(不合并组)。两组患者性别、年龄、出现发热症状比较,差异均无统计学意义(均P>0.05)。相比不合并组,合并组患者腹痛占比较低,发生脓毒血症占比较高,血清ALT水平更高,差异均有统计学意义(均P<0.05)。影像学检查显示脓肿多为单发(70.97%),主要位于右叶(69.35%)。肺炎克雷伯菌是BLA的主要致病菌,占所有致病菌的61.11%,其在合并组中的检出率(76.19%)高于不合并组(40.00%),差异有统计学意义(P<0.05)。结论BLA合并糖尿病患者临床表现多不典型或隐匿,糖尿病患者如出现不明原因发热,无论伴或不伴有腹痛症状均需考虑BLA可能。肺炎克雷伯菌是BLA首位致病菌,在合并糖尿病患者中更为多见。临床医生需及时完善腹部B超或CT检查,并考虑选择覆盖肺炎克雷伯菌敏感的抗生素。

Objective To analyze the clinical characteristics of bacterial liver abscess(BLA)in patients with diabetes.Methods 62 BLA patients admitted to University of Chinese Academy of Sciences Shenzhen Hospital from January 2017 to December 2022 were enrolled,including 28 diabetic patients and 34 non-diabetic patients.The clinical characteristics of BLA were compared between diabetic patients and non-diabetic patients.Results Compared with non-diabetic patients,the incidence of abdominal pain in diabetic patients was significantly lower,the incidence of sepsis and serum ALT levels were significantly higher(all P<0.05).Imaging examination showed that most abscesses were solitary(70.97%),mainly located in the right lobe(69.35%).Klebsiella pneumoniae is the main pathogen of BLA,accounting for 61.11%of all pathogenic bacteria.The detection rate of K.pneumoniae in diabetic patients was 76.19%,which was significantly higher than that in non diabetic patients(40.00%,P<0.05).Conclusion The clinical manifestations of BLA in diabetic patients are generally atypical or insidious.If diabetic patients have fever of unknown origin with or without abdominal pain,BLA should be considered,and abdominal ultrasonography or CT scan are recommended for diagnosis.K.pneumoniae is the most common pathogen for BLA in diabetic patients and appropriate antibiotics should be administrated.