我院10年细菌性肝脓肿临床特征调查分析

肝脏 ›› 2022, Vol. 27 ›› Issue (3): 334-336.

我院10年细菌性肝脓肿临床特征调查分析

尚大宝, 吴波明, 张金铭, 汤伟亮, 赵钢德, 李自强, 卢捷, 谢青, 史冬梅, 项晓刚

200025 上海交通大学医学院附属瑞金医院感染科(尚大宝,张金铭,汤伟亮,赵钢德,李自强,卢捷,谢青,史冬梅,项晓刚);中国科学院大学宁波华美医院肝病科/中国科学院大学宁波生命与健康产业研究院(吴波明)

收稿日期:2021-05-31 出版日期:2022-03-31 发布日期:2022-05-31
通讯作者: 项晓刚,Emil: shine-xxg@163.com
基金资助:
国家自然科学基金面上项目(81970544),上海市优秀学术带头人计划(20XD1422600),上海市人才发展基金(2020097)

A 10-year's survey analysis of the clinical features of pyogenic liver abscess disease in hospital

SHANG Da-bao¹, WU Bo-ming^{1, 2}, ZHANG Jin-ming¹, TANG Wei-liang¹, ZHAO Gang-de¹, LI Zi-qiang¹, LU Jie¹, XIE Qing¹, SHI Dong-mei¹, XIANG Xiao-gang¹

1. Department of Infectious Diseases, Ruijin Hospotal, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Department of Hepatology, Ningbo Huamei Hospital, Chinese Academy of Sciences/ Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang 315010, China

Received:2021-05-31 Online:2022-03-31 Published:2022-05-31
Contact: XIANG Xiao-gang, Emil: shine-xxg@163.com

摘要/Abstract

摘要： 目的探讨细菌性肝脓肿患者的临床特征变化。方法回顾性分析上海交通大学医学院附属瑞金医院2010年3月至2020年12月因细菌性肝脓肿住院治疗的118例患者临床资料。结果近年来细菌性肝脓肿的发病率有所升高,男性多发,发病高峰年龄段在50~80岁。80%~90%患者存在中性粒细胞与C反应蛋白升高,50%以上患者发生贫血、白蛋白减少和红细胞沉降率升高。在常见的临床特征中,近90%病例起病中有发热和寒战,50%有全身乏力,25%有右上腹痛。共45例患者脓液培养或血培养呈阳性,通过二代测序鉴定出病原菌患者为5例(11.1%),45例中肺炎克雷伯菌阳性有33例(脓液培养29例,血培养4例),占培养阳性菌的64.7%,其次为大肠埃希菌6例(脓液培养5例,血培养1例),占培养阳性菌的11.8%。89例患者合并有基础疾病,其中糖尿病57例(64.0%),经导管肝动脉化疗栓塞术后11例(12.4%)。结论糖尿病是细菌性肝脓肿的主要基础疾病,但因肝脏介入术导致的肝脓肿也逐年增多;肺炎克雷伯菌是细菌性肝脓肿的主要致病菌,二代测序在病原鉴定中有一定优势;应根据药敏试验选用抗菌药物。

关键词: 细菌性肝脓肿, 临床特征, 肺炎克雷伯菌, 介入治疗, 二代测序

Abstract: Objective To investigate the changes in disease characteristics of patients with pyogenic liver abscess (PLA) hospitalized in Ruijin Hospital of Shanghai Jiaotong University School of Medicine in the latest 10 years.Methods To retrospectively analyze the clinical data of 106 patients with PLA who were hospitalized in the Department of infectious diseases, Ruijin Hospital from March 2010 to October 2020.Results The incidence of PLA has increased in recent years, and the disease predominantly affects male patients, with a peak age range of 50-80 years. Among all the affected individuals, 80%-90% had elevated neutrophils with acute C-reactive protein elevation, and more than half of the patients developed anemia with reduced albumin and prolonged erythrocyte sedimentation rate. Among the common clinical features, fever and chills occurred in nearly 90% of cases, general malaise in 50%, and right upper abdominal pain in 25%. 45 patients had positive pus cultures or blood cultures, and 5 patients (11.1%) were identified by second-generation sequencing, of which 33 were positive for Klebsiella pneumoniae (29 pus cultures and 4 blood cultures), accounting for 64.7% of culture-positive organisms, followed by 6 cases of Escherichia coli (5 pus cultures and 1 blood culture), accounting for 11.8%. 89 patients were combined with one or more underlying diseases, of which diabetes mellitus accounted for 57 cases (64.0%), and 11 cases (12.4%) have transcatheter arterial chemoembolization (TACE).Conclusion Diabetes mellitus is the main underlying disease of PLA, and cases caused by interventional operation of liver including TACE is rising annually. Klebsiella pneumoniae is the main causative agent of PLA. The second-generation sequencing technique has its advantages. Appropriate antibacterial drugs should be selected according to the pathogenic and pharmacological characteristics in the treatment.

Key words: Pyogenic liver abscess, Clinical features, Klebsiella pneumoniae, Interventional operation, Second-generation sequencing

尚大宝, 吴波明, 张金铭, 汤伟亮, 赵钢德, 李自强, 卢捷, 谢青, 史冬梅, 项晓刚. 我院10年细菌性肝脓肿临床特征调查分析[J]. 肝脏, 2022, 27(3): 334-336.

SHANG Da-bao, WU Bo-ming, ZHANG Jin-ming, TANG Wei-liang, ZHAO Gang-de, LI Zi-qiang, LU Jie, XIE Qing, SHI Dong-mei, XIANG Xiao-gang. A 10-year's survey analysis of the clinical features of pyogenic liver abscess disease in hospital[J]. Chinese Hepatolgy, 2022, 27(3): 334-336.

参考文献

[1] Sharma A, Mukewar S, Mara KC, et al. Epidemiologic factors, clinical presentation, causes, and outcomes of liver abscess: a 35-year olmsted county study. Mayo Clin Proc Innov Qual Outcomes, 2018, 2: 16-25.
[2] Jepsen P, Vilstrup H, Schonheyder H C, et al. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in denmark, 1977-2002. Aliment Pharmacol Ther, 2005, 21: 1185-1188.
[3] Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol, 2004, 2: 1032-1038.
[4] Meddings L, Myers RP, Hubbard J, et al. A population-based study of pyogenic liver abscesses in the united states: incidence, mortality, and temporal trends. Am J Gastroenterol, 2010, 105: 117-124.
[5] Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan . Emerg Infect Dis, 2008, 14: 1592-1600.
[6] Luo M, Yang XX, Tan B, et al. Distribution of common pathogens in patients with pyogenic liver abscess in china: a meta-analysis. Eur J Clin Microbiol Infect Dis, 2016, 35: 1557-1565.
[7] Yang J D, Hainaut P, Gores GJ, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management . Nat Rev Gastroenterol Hepatol, 2019, 16: 589-604.
[8] Tsurusaki M, Murakami T. Surgical and locoregional therapy of HCC: TACE. Liver Cancer, 2015, 4: 165-175.
[9] Lardière-Deguelte S, Ragot E, Amroun K, Et Al. Hepatic abscess: diagnosis and management. J Visc Surg, 2015, 152: 231-243.
[10] González-Alcaide G, Peris J, Ramos JM. Areas of research and clinical approaches to the study of liver abscess. World J Gastroenterol, 2017, 23: 357-365.
[11] Zhou Y, Lu G, Bai Y, et al. Retrospective study of characteristics and management of pyogenic liver abscess during 5 years' experience. Int J Clin Exp Pathol, 2021, 14: 252-260.
[12] Liu L, Chen W, Lu X, et al. Pyogenic liver abscess: a retrospective study of 105 cases in an emergency department from east China. J Emerg Med, 2017, 52: 409-416.
[13] 刘贤贤,成金英,王路路,等. 69例细菌性肝脓肿的临床特征分析. 中国当代医药, 2019, 26: 58-61.
[14] 刘江福,林成祖,柯邵鹏,等. 110例细菌性肝脓肿的临床分析. 中国卫生标准管理, 2017, 27: 42-44.
[15] Siu L K, Yeh K M, Lin J C, et al. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis, 2012, 12: 881-887.
[16] Song YG, Shim SG, Kim KM, et al. Profiling of the bacteria responsible for pyogenic liver abscess by 16s RNA gene pyrosequencing. J Microbiol, 2014, 52: 504-509.