不同脓肿直径的细菌性肝脓肿的临床特征和治疗

摘要/Abstract

摘要： 目的对比并分析不同脓肿直径的细菌性肝脓肿(PLA)患者的临床特征及最常见的大脓肿的治疗方案。方法回顾性分析1 644例PLA成年患者临床资料,根据脓肿直径分为直径≤ 50 mm(小脓肿)组、50~100 mm(大脓肿)组和直径＞100 mm(巨大脓肿)组,比较各组临床特征,并对比分析大脓肿组的两种治疗方式。采用独立样本t检验或Mann-Whitney U检验、Kruskal-Wallis H检验、χ²检验进行统计学分析。结果共纳入小脓肿组597例,大脓肿组944例,巨大脓肿组103例。巨大脓肿组女性(41.7％比32.5％,P<0.05)比例明显高于小脓肿组。大脓肿组和巨大脓肿组发热比例分别为91.4％、81.6％,P＞0.05。巨大脓肿腹痛(64.1％比43.0％,P<0.05)、肺部改变(45.6％比27.5％,P<0.05)及单个病灶(84.3％比71.0％,P<0.05)比例明显高于小脓肿组。三组产气脓肿比例分别为5.2％、12.2％、13.6％,大脓肿和巨大脓肿组明显高于小脓肿组(P<0.05)。三组住院天数分别为12(8,17)d、13(9,19)d和15(10,21)d,住院费用分别为1.83(1.19,2.76)万元、2.31(1.55,3.31)万元、2.58(1.96,3.9)万元,差异有统计学意义(P<0.05)。三组抗生素联合PD治疗比例分别为58.6％、72.7％、75.7％,穿刺次数分别为1(0,1)次、1(0,2)次、1(1,2)次,大脓肿和巨大脓肿组明显高于小脓肿组(P<0.05)。三组白细胞计数分别为10.51(7.67,14.09)×10⁹/L、11.83(9.08,15.33)×10⁹/L、13.19(10.63,18.09)×10⁹/L,丙氨酸氨基转氨酶(ALT)分别为45(27,76.05)U/L、58.4(34,99)U/L、64.1(39,113.5)U/L ,白蛋白分别为33.55(29.5,37.53)g/L、30.6(27,34.8)g/L、27.9(24.48,30.8)g/L,差异均有统计学意义(P<0.05)。在治疗大脓肿方面,抗生素联合PD组住院天数14(10,19)d明显长于单用抗生素组11(6,17)d, P<0.05,且住院费用2.43(1.63,3.43)万元明显高于单用抗生素组1.94(1.12,2.93)万元,P<0.05。抗生素联合PD组好转比例明显高于单用抗生素组(97.5％比87.7％,P<0.05)。但抗生素联合PD组白细胞计数12.26(9.45,15.77)×10⁹/L、ALT 61.4(36.70,104.00)U/L明显高于单用抗生素组11.26(7.95,14.77)×10⁹/L、49.1(28.62,86.82)U/L, P<0.05。结论 PLA患者的脓腔大小与多种因素相关,在大脓肿的治疗方面,抗生素联合PD的治疗与单用抗生素各有利弊。

关键词: 细菌性肝脓肿, 临床特征, 治疗

Abstract: Objective The clinical features of Pyogenic liver abscess (PLA) with two most common treatment approaches for large abscesses were compared and analyzed. Methods Clinical data of 1 644 adult patients with PLA were retrospectively analyzed and divided into groups with diameter ≤ 50 mm (small abscess), 50~100 mm (large abscess), and > 100 mm (giant abscess) according to different abscess diameters. The clinical characteristics of each group were compared, and the two treatment methods of the large abscess group were compared. Independent sample t test, Mann-Whitney U test, Kruskal-Wallis H test and χ² test were used for statistical analysis. Results A total of 597 cases were included in the small abscess group, 944 cases in the large abscess group and 103 cases in the giant abscess group. Women in the giant abscess group (41.7% vs. 32.5%, P<0.05), The proportion was significantly higher than that of small abscess group. The fever ratio of large abscess and large abscess group was 91.4% and 81.6%, respectively, and the difference was not statistically significant (P>0.05). In the giant abscess group, the proportions of abdominal pain (64.1% vs. 43.0%, P<0.05), pulmonary changes (45.6% vs. 27.5%, P<0.05), and single lesion (84.3% vs. 71.0%, P<0.05) were significantly higher than those in the small abscess group. The proportion of gas-forming abscess in the three groups was 5.2%, 12.2% and 13.6%, respectively. The large abscess group and the giant abscess group were significantly higher than those in the small abscess group (P<0.05). The hospitalization days of the three groups were 12(8,17)d, 13(9,19)d and 15(10,21)d, respectively, and the hospitalization costs were 1.83 (1.19, 2.76), 2.31 (1.55, 3.31), and 2.58 (1.96, 3.9) ten thousand yuan, respectively, with statistical significance (P<0.05). The proportions of antibiotics combined with PD in the three groups were 58.6%, 72.7% and 75.7%, and the puncture times were 1 (0,1), 1 (0,2) and 1 (1,2) times, respectively. The large abscess and the giant groups were significantly higher than the small abscess group (P<0.05). Leukocyte count in the three groups was 10.51(7.67,14.09)×10⁹/L, 11.83(9.08,15.33)×10⁹/L, 13.19(10.63,18.09)×10⁹/L, respectively. Alanine aminotransferase (ALT) was 45(27,76.05)U/L, 58.4(34,99)U/L and 64.1(39,113.5)U/L, respectively Albumin was 33.55(29.5,37.53)g/L, 30.6(27,34.8)g/L, 27.9(24.48,30.8)g/L, respectively, and the differences were statistically significant (P<0.05). In the treatment of major abscess, the length of stay 14(10,19)d in PD group combined with antibiotics was significantly longer than 11(6,17) d in antibiotics alone group, P<0.05, and the hospitalization cost of 2.43(1.63,3.43) ten thousand yuan was significantly higher than that of 1.94(1.12, 2.93) ten thousand yuan in antibiotics alone group, P<0.05. The improvement rate of antibiotic combined with PD group was significantly higher than that of antibiotic alone group (97.5% vs. 87.7%, P<0.05). The WBC count of 12.26(9.45,15.77)×10⁹/L and ALT 61.4(36.70,104.00)U/L in antibiotic combined PD group were significantly higher than those in antibiotic alone group 11.26(7.95,14.77)×10⁹/L and 49.1(28.62,86.82)U/L, P<0.05. Conclusion The abscess size in PLA patients is related to many factors. In the treatment of large abscesses, antibiotics combined with PD have advantages and disadvantages compared with antibiotics alone.

Key words: Pyogenic liver abscess, Clinical characteristics, Therapy

张威, 陈国林, 王航, 余良. 不同脓肿直径的细菌性肝脓肿的临床特征和治疗[J]. 肝脏, 2026, 31(1): 107-111.

ZHANG Wei, CHEN Guo-lin, WANG Hang, YU Liang. Clinical characteristics and treatment options of pyogenic liver abscess with different abscess diameters[J]. Chinese Hepatolgy, 2026, 31(1): 107-111.

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