合并肝胆胰疾病的细菌性肝脓肿患者的临床表现及病原学特点分析

Clinical manifestations and etiological features of bacterial liver abscess in patients complicated with hepatobiliary and pancreatic diseases

目的 探讨合并肝胆胰疾病的细菌性肝脓肿患者的临床表现及病原学特点。方法 选取2015年8月至2021年10月北京清华长庚医院细菌性肝脓肿患者115例,按照有无肝胆胰疾病分为有肝胆胰疾病组和无肝胆胰疾病组,比较两组患者的一般情况和临床表现,实验室、病原学和影像学检查结果及预后。结果 115例患者中男76例、女39例,年龄24~92岁,平均(59.8±14.9)岁。与无肝胆胰疾病组相比,有肝胆胰疾病的患者年龄较高[(62.5±11.5)岁比(57.5±17.0)岁],3个月内行胃肠道手术或操作比例较高(38.1%比1.9%),医院获得性感染比例较高(26.9%比1.6%),合并其他部位感染比例较高(26.9%比4.8%),住院时间较长[(22.7±14.6) d比(17.1±9.6) d];序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分较基线增加≥2分比例较高(63.5%比33.3%),发热天数较长[13.0(5.0,30.0) d比4.0(3.0,7.0) d],寒战(69.2%比28.6%)、腹痛(53.8%比23.8%)、黄疸(36.5%比4.8%)及多发肝脓肿灶的比例较高(44.2%比20.6%),CRP较低[(146.9±58.9)mg/L比(175.9±70.7)mg/L],Hb较低[(102.4±24.0)g/L比(131.9±18.3)g/L],ALB较低[(31.8±6.4)g/L比(37.1±5.4)g/L];血培养的耐药菌比例较高(19.2%比1.6%),脓液培养的耐药菌比例较高(11.5%比1.6%),脓液培养的复合菌比例较高(17.3%比1.6%);应用联合抗感染方案比例较高(46.2%比7.9%),60 d死亡比例较高(13.5%比1.6%),差异均具有统计学意义(P <0.05)。结论 有肝胆胰疾病的细菌性肝脓肿患者病情更重、住院时间更长,病原学检查结果更复杂,应充分评估有肝胆胰疾病的细菌性肝脓肿患者耐药菌感染及复合菌感染的风险。

Objective To explore the clinical manifestations and etiological features of bacterial liver abscess in patients complicated with hepatobiliary and pancreatic diseases.Methods A total of 115 patients diagnosed with bacterial liver abscess at Beijing Tsinghua Changgung Hospital from August 2015 to October 2021 were selected,and were divided into two groups,one group with underlying liver,gallbladder and pancreas diseases and the other group without underlying liver,gallbladder and pancreas diseases.The general data,clinical symptoms,laboratory test resuls,etiological test results,imaging findings and prognosis of the two groups were compared.Results Among the 115 patients,there were 76 males and 39 females,aged from 24 to 92 years,with an average age of(59.8 ± 14.9) years.Compared with the group without underlying hepatobiliary and pancreatic diseases,the patients with underlying hepatobiliary and pancreatic diseases had a higher age [(62.5 ± 11.5) years vs.(57.5 ± 17.0) years)],a higher proportion of gastrointestical surgery or operations within three months(38.1% vs.1.9%),a higher proportion of hospital-acquired infection(26.9% vs.1.6%),a higher proportion of infection in other sites(26.9% vs.4.8%),longer hospitalization duration [(22.7 ± 14.6) d vs.(17.1 ± 9.6)d],a higher proportion of the score of sequential organ failure assessment(SOFA) increased by ≥ two points compared with the baseline(63.5% vs.33.3%),longer fever duration [13.0(5.0,30.0) d vs.4.0(3.0,7.0) d],a higher proportion of chills(69.2% vs.28.6%),abdominal pain(53.8% vs.23.8%),jaundice(36.5% vs.4.8%) and multiple liver abscesses(44.2% vs.20.6%),lower CRP [(146.9 ± 58.9) mg/L vs.(175.9 ± 70.7) mg/L)],lower Hb [(102.4 ± 24.0) g/L vs.(131.9 ± 18.3) g/L),lower ALB [(31.8 ±6.4)g/L vs.(37.1 ± 5.4) g/L),a higher proportion of drug-resistant bacteria in blood culture(19.2% vs.1.6%) and a higher proportion of drug-resistant bacteria in pus culture(11.5% vs.1.6%),a higher proportion of complex bacteria in pus culture(17.3% vs.1.6%),a higher proportion of combined anti-infection regimen(46.2% vs.7.9%),and higher mortality rate in 60 d(13.5% vs.1.6%),the differences were statistically significant(all P < 0.05).Conclusions Patients with bacterial liver abscess complicated with underlying hepatobiliary and pancreatic diseases have more severe conditions,and a longer hospital stay with more complex etiological examination results,and should be fully evaluated the risk of drug-resistant bacteria infection and compound bacteria infection.