糖尿病并发细菌性肝脓肿患者的临床特点和治疗疗效分析

摘要/Abstract

摘要： 目的分析糖尿病并发细菌性肝脓肿临床病例的典型特征以及后续治疗疗效,为临床诊疗提供依据。方法选取2019年11月—2023年5月期间长治医学院附属长治市人民医院诊治细菌性肝脓肿患者117例,根据是否合并糖尿病,分为糖尿病组(n=44)和非糖尿病组(n=73),比较患者一般资料、实验室检查、影像学检查,经过观察随访之后进行疗效评判。结果糖尿病组患者寒战和腹痛比例分别为43.2%和65.9%,显著高于非糖尿病组患者(23.3%和35.6%,P<0.05)。糖尿病组患者多发性脓肿比例和脓肿最大直径大于10 cm比例为34.2%和54.5%,显著高于非糖尿病组患者(11.4%和20.5%,P<0.05),脓肿最大直径小于5 cm比例为6.8%,显著低于非糖尿病组患者(30.1%,P<0.05)。糖尿病组患者ALT、AST和TBil水平分别为247.5(84.5, 644.9)U/L、314.1(164.5, 766.2)U/L和68.2(42.7, 135.8)μmol/L,显著高于非糖尿病组患者[48.2(12.3, 134.1)U/L、42.9(15.3, 164.5)U/L和35.1(10.2, 59.3)μmol/L,P<0.05]。糖尿病组患者降钙素原恢复时间、静脉使用抗生素时间和住院时间超过3周比例分别为8.5(5.5, 10.5)d、18.5(12.0, 22.0)d和45.5%,显著高于非糖尿病组[4.5(2.5, 6.0)d、10.0(8.0, 16.0)d和21.9%, P<0.05]。结论合并糖尿病的细菌性肝脓肿患者症状更为多样严重,治疗疗效较差。

关键词: 糖尿病, 细菌性肝脓肿, 临床疗效

Abstract: Objective To analyze the typical characteristics of patients with diabetes complicated by bacterial liver abscess and the curative effect of follow-up treatment, so as to provide basis for clinical diagnosis and treatment. Methods A total of 117 patients with bacterial liver abscess who were admitted to Changzhi People 's Hospital Affiliated to Changzhi Medical between November 2019 and May 2023 were included in the study. Patients were divided into two groups based on the presence or absence of diabetes: a diabetic group (n=44) and a non-diabetic group (n=73). The general data, laboratory examination and imaging examination of patients were compared, and the curative effect was evaluated after observation and follow-up. Results Comparing the general data, it was observed that the proportions of chills and abdominal pain in the diabetic group were 43.2% and 65.9% respectively, which were significantly higher than those in the non-diabetic group [23.3% and 35.6% (P<0.05)]; comparing the imaging results, it can be seen that the proportion of patients with multiple abscesses and the proportion of abscesses with a maximum diameter greater than 10cm in the diabetic group were 34.2% and 54.5%, which were significantly higher than those in the non-diabetic group [11.4% and 20.5% (P<0.05)]. The proportion of abscesses with a maximum diameter less than 5cm was 6.8%, significantly lower than the patients in the non-diabetic group (30.1%) (P<0.05); Comparing the laboratory test results, it can be seen that the levels of ALT, AST and TBil in the diabetic group were 247.5 (84.5, 644.9) U/L and 314.1 (164.5, 164.5, respectively). 766.2) U/L and 68.2 (42.7, 135.8) μmol/L, which were significantly higher than those in the non-diabetic group [48.2 (12.3, 134.1) U/L, 42.9 (15.3, 164.5) U/L and 35.1 (10.2, 59.3 ) μmol/L (P<0.05)]; Comparing the efficacy, it can be seen that the procalcitonin recovery time, intravenous antibiotic use time and hospitalization time of more than three weeks in the diabetes group were 8.5 (5.5, 10.5) days and 18.5 (12.0, 12.0, respectively). 22.0) days and 45.5%, which were significantly higher than the non-diabetic group [4.5 (2.5, 6.0) days, 10.0 (8.0, 16.0) days and 21.9% (P<0.05)]. Conclusion Patients with bacterial liver abscess complicated by diabetes have more diverse and severe symptoms and poorer treatment efficacy.

Key words: Diabetes, Bacterial liver abscess, Clinical efficacy

姚娜, 董鹏刚, 陈丽, 赵文化, 许林鑫. 糖尿病并发细菌性肝脓肿患者的临床特点和治疗疗效分析[J]. 肝脏, 2025, 30(2): 249-252.

YAO Na, DONG Peng-gang, CHEN Li, ZHAO Wen-hua, XU Lin-xin. Clinical characteristics and therapeutic efficacy of patients with diabetes complicated by bacterial liver abscess[J]. Chinese Hepatolgy, 2025, 30(2): 249-252.

/ 推荐

参考文献

[1] 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[J]. Am J Gastroenterol, 2010, 105(1): 117-124.
[2] Gallagher MC, Andrews MM. Postdischarge outcomes of pyogenic liver abscesses: single-center experience 2007-2012[J]. Open Forum Infect Dis, 2017, 4(3): ofx159.
[3] Chen YC, Lin CH, Chang SN, et al. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the national health insurance research database of taiwan, 2000-2011[J]. J Microbiol Immunol Infect, 2016, 49(5): 646-653.
[4] Li W, Chen H, Wu S, et al. A comparison of pyogenic liver abscess in patients with or without diabetes: a retrospective study of 246 cases[J]. BMC Gastroenterol, 2018, 18(1): 144.
[5] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409.
[6] Pawar A, Khadanga S, Singhai A. An immunocompetent adult male presented with a liver abscess caused by the mycobacterium tuberculosis: a case report from india[J]. Case Rep Infect Dis, 2023, 2023: 9049315.
[7] Khim G, Em S, Mo S, et al. Liver abscess: diagnostic and management issues found in the low resource setting[J]. Br Med Bull, 2019, 132(1): 45-52.
[8] Schwarz C, Mathieu J, Gomez JL, et al. Unexpected finding of fusobacterium varium as the dominant fusobacterium species in cattle rumen: potential implications for liver abscess etiology and interventions[J]. J Anim Sci, 2023, 101.
[9] Carvalho M, Dunne P, Kwasnicka D, et al. Barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesi[J]s. HRB Open Res, 2021, 4: 129.
[10] Ayanian JZ. Community health centers caring for adults with hypertension and diabetes[J]. JAMA Health Forum, 2021, 2(9): e212678.
[11] Wazqar AA, Baatya MM, Lodhi FS, et al. Assessment of knowledge and foot self-care practices among diabetes mellitus patients in a tertiary care centre in makkah, saudi arabia: a cross-sectional analytical study[J]. Pan Afr Med J, 2021, 40: 123.
[12] Heidari Z, Asadzadeh R. Subclinical hypothyroidism is a risk factor for diabetic retinopathy in patients with type 2 diabetes mellitus[J]. Med J Islam Repub Iran, 2021, 35: 186.
[13] Fasina I, Agyei O, Kim J, et al. Interprofessional continuous glucose monitoring for underserved adults with type 2 diabetes on insulin or secretagogues[J]. Innov Pharm, 2021, 12(4): 10.
[14] Jindal A, Pandey A, Sharma MK, et al. Management practices and predictors of outcome of liver abscess in adults: a series of 1630 patients from a liver unit[J]. J Clin Exp Hepatol, 2021, 11(3): 312-320.
[15] Cao SA, Hinchey S. Identification and management of fusobacterium nucleatum liver abscess and bacteremia in a young healthy man[J]. Cureus, 2020, 12(12): e12303.
[16] Stotz MK, Henry DD, Crossland WL. Evaluation of immunoglobulin-y in place of tylosin phosphate in the diets fed to holstein steers and preliminary analysis of liver abscess duration on animal growth performance[J]. Transl Anim Sci, 2021, 5(1): txaa225.
[17] Kaiser RWJ, Allgeier J, Philipp AB, et al. Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report[J]. BMC Gastroenterol, 2020, 20(1): 424.
[18] Yin D, Ji C, Zhang S, et al. Clinical characteristics and management of 1572 patients with pyogenic liver abscess: a 12-year retrospective study[J]. Liver Int, 2021, 41(4): 810-818.