肺炎克雷伯菌肝脓肿的临床及影像学特征  

The clinical and radiological features of Klebsiella pneumoniae liver abscesses

作　　者：李婧[1] 符颖[1] 王吉耀[1] 曾蒙苏[2] 涂传涛[1] 沈锡中[1] 蒋炜[1] 

机构地区：[1]复旦大学附属中山医院消化科,上海200032 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《中华消化杂志》2010年第4期230-235,共6页Chinese Journal of Digestion

摘　　要：目的通过全面评价肺炎克雷伯菌所致肝脓肿（KLA）患者的临床及影像学特征，使之能及时得到针对性治疗。方法收集2001年3月至2009年1月期间入院的197例细菌性肝脓肿患者，其中KLA106例，非肺炎克雷伯菌单菌感染所致肝脓肿（NKLA）56例，对其基础疾病、临床表现、实验室检查以及B超、CT等影像学资料进行回顾性分析。结果在基础疾病方面，KLA患者多伴发糖尿病（53．77％比25．00％，P=0．001）、脂肪肝（16．04％比5．36％，P〈0．05）。在临床表现方面，KLA患者在腹痛（40．57％比57．14％，P〈0．05）、乏力（19．81％比46．43％，P＝0．001）、肝肿大（4．72％比14．29％，P〈0．05）方面较NKLA患者表现不明显。在实验室检查方面，KLA入院时空腹血糖水平较高[（7．84±0．36）mmol／L比（5．76±0．30）mmol／L，P＝0．001]。影像学检查方面，两组患者皆多为右叶单发脓肿，CT检查结果提示，KLA的脓肿气腔发生率高（32．88％比13．51％，P〈0．05）、边缘更为模糊（71．23％比40．54％，P〈0．05），且动脉期多呈现分隔强化（41．10％比16．22％，P〈0．01）。结论克雷伯菌已成为细菌性肝脓肿的主要致病菌。KLA多伴发糖尿病、脂肪肝，临床症状轻，脓肿气腔发生率高，通过影像学可对其初步诊断，及时进行针对性治疗。Objective To comprehensively evaluate the clinical and radiological features of patients with Klebsiella pneumonia liver abscess （KLA） in order to improve treatment. Methods Data of 197 patients with KLA （n=106） or non-KLA （n 56） between March 2001 and January 2009 were collected and retrospectively analyzed on the aspects of underlying diseases, clinical manifestations, laboratory tests, pathogenic and imaging examinations. Results In comparison with non-KLA patients, the underlying diseases such as diabetes （53. 77% vs 25.00%, P=0. 001） and hepatic adipose infiltration （16. 04% vs 5. 36%, P〈0.05） were more common in KLA patients. Whereas the clinical presentations including abdominal pain （57. 14% vs 40. 57%, P〈 0. 05）, hypodynamia （46.43% vs 19.81%, P=0.001） and hepatomegaly （14.29% vs 4.72%, P〈0.05） were more severe in non-KLA patients than in KLA patients, however, the fasting blood glucose was higher in KLA patients than in non-KLA patients [ （7.84±0.36） mmol/L vs （5.76±0.30） mmol/L, P=0. 001] on the admission. In addition, the abscess of KLA often appeared alone in the right lobe of the liver and was liable to generate air cavity （32. 88% vs 13. 51%, P〈0. 05）, un-smooth rim （71.23% vs 40. 54% ,P〈0.05） and dynamic septum enhancement （41.10% vs 16.22% ,P〈0.01） in comparison with non-KLA. Conclusions Klebsiella pneumonia has emerged as the main pathogen of pyogenic liver abscess. The patients with KLA are often complicated with diabetes and fatty liver, as well as high prevalence of air cavity. The CT findings may be helpful for prompt treatment of Klebsiella pneumonia liver abscess.

关 键 词：肝脓肿 肺炎克雷伯杆菌 计算机体层成像 

分 类 号：R575.4[医药卫生—消化系统]