肺炎克雷伯菌肝脓肿的临床及微生物特征分析  

The clinical and bacterial features of Klebsiell a pnuemoniae liver abscess

作　　者：吴华[1] 李东冬[1] 王京[1] 孙运芳[1] 叶丽艳[1] 沈定霞[1] 

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中华医学杂志》2015年第40期3259-3263,共5页National Medical Journal of China

基　　金：国家自然科学基金（81472012）

摘　　要：目的 对肺炎克雷伯菌肝脓肿的临床特征和致病菌的微生物特性进行总结,为临床的诊治提供依据.方法 采用回顾性分析方法,收集2010年1月至2014年12月就诊于北京3家教学医院,经B超或CT诊断为肝脓肿、脓肿穿刺物培养为肺炎克雷伯菌的152例患者病历,对其中137份完整的病历进行分析;对来自肝脓肿的非重复患者的152株肺炎克雷伯菌进行黏丝试验确定高黏液性状,使用PCR方法进行荚膜血清分型和毒力基因检测,K-B法进行药敏试验,采用χ2 检验对结果进行统计分析.结果 肺炎克雷伯菌肝脓肿多发生于中老年男性及糖尿病患者,92.7%（127/137）有发热,80.3%（110/137）的脓肿为单发,单发脓肿中80.9%（89/110）发生于右叶,33.6%（46/137）的脓肿内可见气体;74.5%（102/137）的白细胞计数、83.2%（114/137）的中性粒细胞百分比、78.1%（107/137）的谷丙氨酸转氨酶和51.8%（71/137）的胆红素升高.87.5%（133/152）菌株属于高黏液型;K1型是最常见的血清型,其次为K2 型;毒力基因 rmpA 和气杆菌素的检出率分别为82.9%（126/152）和88.2%（134/152）;不伴其他肝胆疾病的肝脓肿的K1型比例、rmpA和气杆菌素检出率分别为65.7%、94.9%和96.0%,高于伴有其他肝胆疾病肝脓肿的28.9%、50.0%和68.4%,差异有统计学意义（x2 =14.98、38.40、17.61,均P〈0.01）,未分型比例为5.1%,低于伴有其他肝胆疾病脓肿的26.3%,差异有统计学意义（x2 =10.65,P〈0.01）.肺炎克雷伯菌对常见抗生素的耐药率较低.结论 肺炎克雷伯菌肝脓肿多由高黏液、携带毒力基因rmpA和气杆菌素的高毒力肺炎克雷伯菌引起,大多数菌株对抗生素尚敏感.Objective To summarize the clinical and bacterial features of Klebsiella pnuemoniae liver abscess （KPLA） in order to provide the basis for the diagnosis and treatment of KPLA.Methods Retrospective study was conducted.One hundred and fifty-two medical records, from 3 teaching hospitals in Beijing, between January 2010 and December 2014, were collected.Among which 137 complete medical records were analyzed.String test was carried out to detect the hypermucoviscosity phenotype.PCR was performed to check the capsular serotype and the virulent genes.Disk diffusion method was operated to obtain the antimicrobial resistance rates.The results were analyzed by chi-square test.Results KPLA occurred mostly in middle-aged, male and diabetes mellitus patients.92.7%（127/137） patients had fever.80.3%（110/137） of the KLPA were single abscess , among which 80.9%（89/110） were in the right lobe and 33.6% （46/137） had air cavities.74.5% （102/137） of the white blood cell count , 83.2%（114/137） of the neutrophils＇percentage, 78.1% （107/137） of alanine aminotransferase and 51.8%（71/137） of the total billrubin were elevated.87.5% （133/152） of the Klebsiella pnuemoniae （Kpn） appeared to be hypermucoviscous , K1 was the most popular serotype , the second was K2, and the positive rates of virulent genes rmpA and aerobactin were 82.9%（126/152） and 88.2%（134/152）, respectively.Among the isolates from the KPLA without other hepatobiliary diseases , the portion of K1 serotype, the positive rates of rmpA and aerobactin were 65.7%, 94.9%and 96.0%, respectively , higher than those of the 28.9%, 50.0% and 68.4% from the KPLA with other hepatobiliary diseases , while the undefined serotype potion was lower （5.1% vs 26.3%）, the differences were statistically significant （χ2 =14.98, 38.40, 17.61, 10.65, all P〈0.01）.Most of Kpn were susceptible to antimicrobials.Conclusions KPLA has certain clinical features , and are mostly caused by hypervirulent isolates that are hypermucoviscous with

关 键 词：肝脓肿 肺炎克雷伯菌 临床表现 高毒力 耐药率 

分 类 号：R575.4[医药卫生—消化系统]