56例肝脓肿患者临床表现和病原学分析

摘要/Abstract

摘要： 目的比较病原学阳性与病原学阴性肝脓肿患者临床资料。方法纳入2017年1月至2020年12月肝脓肿患者62例。收集病原学阴性、阳性肝脓肿患者临床资料并进行;根据病原菌不同,将病原学阳性肝脓肿分为大肠埃希菌组(EC组)、肺炎克雷伯菌组(KP组),同时比较临床资料。结果病原学阴性、阳性肝脓肿患者分别为40例、22例。病原学阴性、阳性肝脓肿患者年龄为53(40,70)岁、58(46,66)岁,差异有统计学意义(P<0.05);病原学阴性、阳性肝脓肿患者糖尿病为7例(17.5%)、9例(40.9%),差异有统计学意义(P<0.05)。病原学阴性肝脓肿患者WBC、中性粒细胞百分比、ALP、GGT及TBil分别为11.6(2.6,18.2)×10⁹/L、80.2(36.0,96.4)%、56(22,214)U/L、67(18,202)U/L及24.6(6.8,34.8)μmol/L,病原学阳性肝脓肿患者为14.5(3.3,30.8)×10⁹/L、86.2(68.3,98.6)%、126(20,462)U/L、144(16,507)U/L及28.8(10.1,48.4)μmol/L,差异有统计学意义(P<0.05);病原学阴性、阳性肝脓肿患者脓肿直径为4.2(3.0,5.8)cm、5.5(4.0,7.0)cm,差异具有统计学意义(P<0.05)。病原学阳性肝脓肿患者中EC、KP病原菌分别为16例(EC组)、6例(KP组)。EC组年龄、男性、糖尿病及腹痛分别为52(45,66)岁、12例、9例及4例,KP组分别为61(52,70)岁、2例、0及4例,差异有统计学意义(P<0.05);EC组ALP、GGT及TBil为115(14,450)U/L、126(12,480)U/L及23.7(9.6,20.4)μmol/L,KP组分别为141(94,670)U/L、170(84,507)U/L及34.5(18.7,52.5)μmol/L,差异有统计学意义(P<0.05);EC组多个脓腔、脓腔气体形成及脓腔分隔形成为3例、4例及3例,KP组分别为5例、0及0,差异有统计学意义(P<0.05)。病原学阴性、阳性肝脓肿患者治疗良好分别为29例(72.5%)、16例(72.7%),差异无统计学意义((P>0.05),住院时间分别为(18.8±5.2)d,(17.0±5.0)d,(P>0.05),无死亡病例;EC组、KP组住院时间为(18.5±5.0)d,(19.4±6.0)d,(P>0.05)。结论病原学阴性肝脓肿患者年龄较小,不易出现较重的炎症反应和肝功能不全。病原学阳性肝脓肿患者脓腔气体和脓腔形成,KP感染可能性大。

关键词: 肝脓肿, 大肠埃希菌, 肺炎克雷伯杆菌

Abstract: Objective To review the clinical data of patients with pathogen-positive liver abscess (LA) and compare it with pathogen-negative liver abscess, so as to provide guidance for clinical condition evaluation and treatment strategy formulation of liver abscess. Methods From January 2017 to December 2020, 62 LA patients (43 males and 19 females) were collected, aged 55 (40, 68) years. To compare the clinical data of patients with pathogen-negative and pathogen-positive LA. According to different pathogenic bacteria, pathogen-positive LA was divided into Escherichia coli group (EC group) and Klebsiella pneumoniae group (KP group), and the clinical data were compared. Results There were 40 patients with pathogen-negative LA and 22 patients with pathogen-positive LA. The patients with pathogen-negative and pathogen-positive LA were 53 (40, 70) years old and 58 (46, 66) years old, and the difference was statistically significant (P<0.05). There were 7 cases (17.5%) and 9 cases (40.9%) of diabetes in pathogen-negative and pathogen-positive LA patients, and the difference was statistically significant (P<0.05). The white blood cell (WBC), neutrophil percentage, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and total bilirubin (Tbil) in patients with pathogen-positive liver abscess were 11.6 (2.6, 18.2)×10⁹/L, 80.2 (36.0, 96.4)%, 56 (22, 214) U/L, 67 (18, 202) U/L and 24.6 (6.8,34.8) μmol/L, compared with 14.5 (3.3, 30.8)×109/L, 86.2 (68.3, 98.6)%、126 (20, 462) U/L, 144 (16, 507) U/L and 28.8 (10.1, 48.4) μmol/L in pathogen-negative LA, the difference was statistically significant (P<0.05). The diameters of abscesses in patients with pathogen-negative and pathogen-positive LA were 4.2 (3.0, 5.8) cm and 5.5 (4.0, 7.0) cm, with statistical significance (P<0.05). The EC and KP pathogens in pathogen-positive LA patients were 16 cases (EC group) and 6 cases (KP group), respectively. According to the clinical data of the two groups, the age, male, diabetes and abdominal pain in EC group were 52 (45,66) years old, 12 cases (75.0%), 9 cases (56.2%) and 4 cases (25.0%), compared with those in KP group [61 (52,70) years old, 2 cases (33.3%), 0 (0) and 4 cases (66.7%)], with statistical significance (P<0.05). The ALP, GGT and TBil in EC group were 115 (14,450) U/L, 126 (12, 480) U/L and 23.7 (9.6, 20.4) μmol/L, which were higher than those in KP group [141 (94, 670) u/l, 170 (84, 507)U/L and 34.5 (18.7, 52.5) μmol/L (P<0.05). There were 3 cases (18.7%), 4 cases (25.0%) and 3 cases (18.7%) with multiple purulent cavities, gas formation of purulent cavities and separation of purulent cavities in EC group, and the difference was statistically significant compared with KP group [5 cases (83.3%), 0 cases (0) and 0 cases (0)] (P<0.05). The treatment strategy is anti-infection combined with ultrasound or CT guided abscess puncture drainage. Three generations of cephalosporins combined with ornidazole and β-lactamase inhibitors were selected as the anti-infection scheme. There were 29 cases (72.5%) and 16 cases (72.7%) of patients with negative and positive LA treated well, respectively, and the difference was not statistically significant (P>0.05). There was no significant difference between the two groups in hospital stay [(18.8 ± 5.2) days vs (17.0 ± 5.0) days, P>0.05]. There was no significant difference in hospitalization time between EC group and KP group [(18.5 ± 5.0) days compared with (19.4 ± 6.0) days, P>0.05]. Conclusion Patients with pathogen-negative LA are younger, so they are less likely to have severe inflammatory reaction and hepatic insufficiency. If pyogenic gas and pyogenic cavity are formed in pathogen-positive LA patients, KP infection is more likely. There is no significant difference in the overall prognosis of LA patients in each group.

Key words: Liver abscess, Escherichia coli, Klebsiella pneumoniae

王军, 杨柳青. 56例肝脓肿患者临床表现和病原学分析[J]. 肝脏, 2022, 27(9): 1021-1024.

WANG Jun, YANG Liu-qing. Clinical manifestations and etiological analysis of 56 patients with liver abscess[J]. Chinese Hepatolgy, 2022, 27(9): 1021-1024.

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