失代偿期肝硬化合并肝外脓肿患者临床特点分析

Clinical feature of extra-liver abscess in patients with decompensated liver cirrhosis

目的分析失代偿期肝硬化合并肝外脓肿的临床特点、可能原因和预后。方法2016年10月~2021年10月我院诊治的失代偿期肝硬化合并肝外脓肿(ELA)患者79例和同期收治的失代偿期肝硬化合并肝脓肿(LA)患者49例,给予抗生素联合局部引流或抗生素联合外科手术治疗,常规取标本行细菌培养和鉴定。结果ELA与LA组肝硬化主要病因均为乙型肝炎,分别占60.8%和50.1%(P>0.05),ELA组合并胆道结石占比为2.5%,显著低于LA组的59.2%(P<0.05),两组合并糖尿病占比无显著性差异(13.9%和22.4%,P>0.05);两组致病菌均以革兰氏阴性菌为主(52.5%和64.7%,P>0.05),其中主要为大肠埃希氏菌(22.5%和17.6%)和肺炎克雷伯菌(20.0%和35.3%);ELA组包括42例皮肤软组织脓肿(SSTA)和37例深部脓肿(DA);ELA组治愈率为67.1%,显著低于LA组的91.8%(P<0.05);DA组患发热性疾病、1年内因感染、发生肝衰竭和有创性操作反复住院占比显著高于SSTA组,而入院前病程显著长于SSTA组(P<0.05)。结论失代偿期肝硬化患者易发生ELA,其中不乏DA,常见病原菌为肺炎克雷伯杆菌和大肠埃希氏菌,部分患者预后差,避免侵入性操作等诱发因素,可能减少其发生的机会。

Objective This study was conducted to summarize clinical feature,risk factors and prognosis of patients with extra-liver abscesses(ELA)and decompensated liver cirrhosis(DLC).Methods 79 DLC patients with ELA and 49 cirrhotics with liver abscesses(LA)were encountered in our hospital between October 2016 and October 2021,and all patients in the two groups were managed by antibiotic administration and local drainage or surgical operation.Bacterial culture and characterization were carried out routinely.Results The causes of LC in both groups were predominantly hepatitis B viral infections,accounting for 60.8%and 50.1%,respectively(P>0.05),and a significant lower proportion(2.5%)of concurrent biliary stones in the ELA group was foundas compared to(59.2%)in the LA group(P<0.05);there was no significant disparity in the prevalence of coexisting diabetes mellitus between the two groups 3.9%vs.22.4%(P>0.05);predominant causative organisms in both groups were gram-negative bacteria,withEscherichia Coli(22.5%vs.17.6%)and KlebsiellaPneumoniae(20.0%vs.35.3%)being the most prevalent;the abscess inELA group included skin and soft tissue abscess(SSTA)in 42 cases and deepabscess(DA)in 37 cases;the recovery rate in patients with ELA was 67.1%,much lower than91.8%(P<0.05)in those with LA;the predisposing factors in patients with DA included recurrent fever,repeated hospitalization because of infection,liver failure and invasive manipulation,and delayed hospitalization was more common(P<0.05).Conclusion ELA is frequently occurred in patients withDLC with a bleak prognosis,especially in those with DA,and the prevalent pathogens are Klebsiella Pneumoniae and Escherichia Coli.Refraining from predisposing factors and early seeing doctors might improve the prognosis.