细菌性肝脓肿患者临床特征分析

Clinical characteristics of pyogenic liver abscess

目的观察细菌性肝脓肿患者主要致病菌及预后情况,分析不同年龄细菌性肝脓肿患者临床特征。方法2021年1月—2022年4月首都医科大学附属北京友谊医院诊治细菌性肝脓肿患者103例,根据年龄分为老年组(≥65岁)43例和非老年组(<65岁)60例,比较2组基础疾病、临床症状、入院时实验室指标、血培养和脓液培养结果、影像学表现(脓肿部位、个数、直径)、并发症(肺部感染、胸腔积液、脓毒症、脓毒性休克)发生情况、治疗方式、住院时间及预后情况。结果老年组高血压比率(58.1%)高于非老年组(36.7%)(χ^(2)=4.655,P=0.031),寒战比率(67.4%)低于非老年组(88.3%)(χ^(2)=6.735,P=0.009),冠心病、脑梗死、糖尿病、发热、恶心、腹痛、腹泻比率与非老年组比较差异均无统计学意义(P>0.05)。老年组中性粒细胞百分比[(86.14±7.29)%]高于非老年组[(83.00±7.08)%](t=2.193,P=0.031),淋巴细胞百分比[(7.75±5.55)%]低于非老年组[(10.27±5.97)%](t=2.178,P=0.032),白细胞计数、血小板计数、凝血酶原活动度及血红蛋白、C反应蛋白、白蛋白、谷丙转氨酶、总胆红素、血肌酐、血糖水平与非老年组比较差异均无统计学意义(P>0.05)。103例患者行血液培养,67例患者行脓液培养,老年组血培养阳性率(46.5%)、脓液培养阳性率(83.3%)与非老年组(31.7%、86.0%)比较差异均无统计学意义(χ^(2)=2.346,P=0.126;χ^(2)<0.001,P>0.999)。血培养或脓液培养检出肺炎克雷伯菌62例(60.2%),其中有糖尿病病史30例(48.4%);脓液培养检出大肠埃希菌2例;脓液或血培养检出表皮葡萄球菌、粪肠球菌、脆弱拟杆菌、人葡萄球菌、头状葡萄球菌、溶血葡萄球菌、多形拟杆菌、中间链球菌、铜绿假单胞菌、星座链球菌各1例。2组脓肿部位、脓肿个数、脓肿直径及肺部感染、胸腔积液、脓毒症、脓毒性休克发生率比较差异均无统计学意义(P>0.05)。67例行超声引导下穿刺抽吸/置管引流联合抗感染治疗,其中1例引流充分后行手术治疗;36例患者行抗感染保守治疗。2组治疗方式、住院时间比较差异均无统计学意义(P>0.05)。103例患者中治愈出院98例(95.1%)。结论细菌性肝脓肿患者主要致病菌为肺炎克雷伯菌,超声引导下穿刺抽吸/置管引流联合抗感染治疗或抗感染保守治疗均有效,总体预后较好;与非老年患者相比,老年患者高血压比率、中性粒细胞百分比较高,寒战比率、淋巴细胞百分比较低,其他临床症状、实验室指标、病原学及影像学检查无特异性。

Objective To observe the main pathogens and prognosis of pyogenic liver abscess,and to analyze the clinical characteristics of patients with different ages.Methods Totally 103 patients with pyogenic liver abscess in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2021 to April 2022 were divided into elderly group(≥65 years old,n=43)and non-elderly group(<65 years old,n=60).The age,underlying diseases,clinical symptoms,laboratory indexes,results of blood culture and pus culture,imaging features(site,number and diameter of abscess),complications(pulmonary infection,pleural effusion,sepsis and septic shock),treatment mode,length of hospital stay and prognosis were compared between two groups.Results The rate of hypertension was higher in elderly group(58.1%)than that in non-elderly group(36.7%)(χ^(2)=4.655,P=0.031),the rate of chills was lower in elderly group(67.4%)than that in non-elderly group(88.3%)(χ^(2)=6.735,P=0.009),and there were no significant differences in the rates of coronary heart disease,cerebral infarction,diabetes,fever,nausea,abdominal pain and diarrhea between two groups(P>0.05).The percentage of neutrophil was higher in elderly group[(86.14±7.29)%]than that in non-elderly group[(83.00±7.08)%](t=2.193,P=0.031),the percentage of lymphocyte was lower in elderly group[(7.75±5.55)%]than that in non-elderly group[(10.27±5.97)%](t=2.178,P=0.032),and there were no significant differences in the white blood cell count,platelet count,prothrombin activity,hemoglobin,C-reactive protein,albumin,glutamic-pyruvic transaminase,total bilirubin,creatinine and blood glucose levels between two groups(P>0.05).Totally 103 patients received blood culture and 67 received pus culture.The positive rates of blood culture and pus culture showed no significant differences between elderly group(46.5%,83.3%)and non-elderly group(31.7%,86.0%)(χ^(2)=2.346,P=0.126;χ^(2)<0.001,P>0.999).Klebsiella pneumoniae was detected by blood culture or pus culture in 62 patients(60.2%),among whom 30 patients(48.4%)had a history of diabetes.Escherichia coli was detected by pus culture in 2 patients.Staphylococcus epidermidis,Enterococcus faecalis,Bacteroides fragilis,Staphylococcus hominis,Staphylococcus capitis,Staphylococcus haemolyticus,Bacteroides polymorphus,Streptococcus intermedia,Pseudomonas aeruginosa and Streptococcus constellatus were detected by pus or blood culture in 1 patient each.There were no significant differences in the site,number and diameter of abscess,and the incidences of pulmonary infection,pleural effusion,sepsis and septic shock between two groups(P>0.05).Sixty-seven patients received ultrasound-guided aspiration/catheter drainage combined with anti-infective treatment,among whom 1 patient was performed surgery after sufficient drainage,and 36 patients received conservative anti-infective treatment.There were no significant differences in the treatment mode and length of hospital stay between two groups(P>0.05).Of 103 patients,98(95.1%)were discharged after recovery.Conclusions Klebsiella pneumoniae is the main pathogen in patients with pyogenic liver abscess.Both ultrasound-guided aspiration/catheter drainage combined with anti-infective treatment and conservative anti-infective treatment are effective,and the overall prognosis is good.Compared with non-elderly patients,the elderly patients have higher rate of hypertension,higher percentage of neutrophil,lower rate of chills and lower percentage of lymphocyte,with no specificity in other clinical symptoms,laboratory indexes,etiology and imaging reults.