糖尿病合并肝脓肿的临床特点和治疗

A study on the clinical characteristics and treatment of diabetes mellitus complicated by hepatic abscess

目的 探讨糖尿病合并肝脓肿 (diabetichepaticabscess ,DHA)的临床特点和有效治疗方法。方法 对 1994年 5月～ 2 0 0 3年 3月我院收治的 2 9例DHA和 6 4例非糖尿病肝脓肿 (nondiabetiche paticabscess ,NDHA)进行对比总结。结果 2 9例DHA均为 2型糖尿病患者 ,老年人居多 ,男女发病相似 ,6 4例NDHA以中年人为多 ,男略多于女 ;DHA的诱因主要为肺部感染、胆囊炎胆结石、尿路感染、腹腔肿瘤 ,而NDHA为胆道疾患、腹腔手术等 ;病原菌DHA主要为肺炎克雷伯杆菌、坚实牙胞杆菌、大肠杆菌 ,NDHA为粪肠球菌、模仿葡萄球菌、肺炎克雷伯杆菌等 ;DHA组治愈率较NDHA组低 ( 37.9%和 6 2 .5 % ) ,P <0 .0 5 ;平均住院时间较NDHA组长 ,分别为 ( 32 .4± 10 .2 )d和 ( 2 3.8± 11.1)d ,P <0 .0 5 ;DHA组应用抗生素时间较NDHA组长而量大。结论 DHA是糖尿病感染中严重的感染症之一 ,与长期高血糖有关。及早用胰岛素控制血糖至正常、应用足量抗革兰阴性杆菌抗生素控制感染、及时脓液穿刺手术 。

Objective To investigate the clinical characteristics and treatment of diabetic hepatic abscess (DHA).Methods 29 cases of DHA and 64 cases of nondiabetic hepatic abscess (NDHA) were retrospectively analyzed.Results 29 cases of DHA were all type 2 diabetes mellitus,and DHA occurred more frequently in senile patients,with similar morbidity in both sexes. The predisposing factors of DHA were pulmonary infection,acute cholecystitis,urinary tract infection and intraabdominal tumor;while in NDHA, biliary tract disorder and intraabdominal operation were main inducing factors. Klebsiella pneumoniae,Bacillus ceaeus and Escherichia coli were the major pathogens in DHA,while Enterococcus faecalis staphylococcus simulans,Klebsiella pneumoniae and so on in NDHA.The cure rate in DHA was lower than that in NDHA (37.9% vs 62.5%),P<0.05,and the mean hospitalization time in DHA was longer than that in NDHA (32.4±10.2 vs 23.8±11.1 days),P<0.05.Conclusion DHA is one of the severe infections in patients with diabetes mellitus, and prompt drainage ,early administration of insulin and adequate antibiotics are of most importance to the prognosis of DHA.