肝脓肿合并糖尿病的病原学及临床特征  

The microbiological and clinical characteristics of pyogenic liver abscesses in patients with diabetes mellitus

作　　者：杜兰芳[1] 刘桂花[1] 田兆兴[1] 

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中国中西医结合急救杂志》2016年第4期364-367,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金（81172745）

摘　　要：目的比较糖尿病与非糖尿病细菌性肝脓肿患者病原学以及临床特征的差异。方法采用回顾性研究方法，选择2010年1月至2015年1月就诊于北京大学第三医院的细菌性肝脓肿患者60例，按照有无糖尿病分为糖尿病组和非糖尿病组。比较两组临床特点、病原学及相关实验室检查的差异。结果共有60例患者入选，其中50％（30／60）的患者合并糖尿病。与非糖尿病组比较，糖尿病组容易误诊漏诊，其发病至确诊需就诊2次及以上的比例显著增加[43．3％（13／30）比73．3％（22／30），P〈0．05]，发病至确诊的时间显著延长[d：5．5（1．0。20．0）比9．0（1．0-60．0），P〈0．05]。糖尿病组患者肺炎克雷伯杆菌感染的比例较非糖尿病组显著增加[5313％（16／30）比16．7％（5／30），P〈0101]。糖尿病组患者中性粒细胞比例显著低于非糖尿病组[0．85（0．50～0．98）比0．89（0．77．0．97）]，其发热持续时间（d：21±15比13±7）、住院费用[万元：2．4（0．8～18．0）比1．6（0．4．7．8）]均显著高于非糖尿病组（均P〈0．05）。结论糖尿病是细菌性肝脓肿的重要危险因素，但肝脓肿合并糖尿病时容易误诊漏诊，肺炎克雷伯杆菌肝脓肿尤其多见于糖尿病者。Objective To compare the differences in microbiological and clinical characteristics between pyogenic liver abscesses （PLA） in patients with diabetes mellitus （DM） and non-DM. Methods A retrospective study was conducted, and the patients with PLA admitted to Peking University Third Hospital from January 2010 to January 2015 were enrolled. They were divided into DM and non-DM groups. The differences in clinical characteristics, microbiology and related laboratory tests between the two groups were compared. Results In the 60 PLA patients enrolled, 50% （30/60） were accompanied by DM. Compared with the non-DM group, the PLA patients in DM group were more easily to be misdiagnosed, the ratio of doctor＇s visits necessary for ≥ 2 times was more in the DM group [43.3% （13/30） vs. 73.3% （22/30）, P 〈 0.05], and the interval between the onset to accurate diagnose was obviously longer in the DM group [days： 5.5 （1.0-20.0） vs. 9.0 （1.0-60.0）, P 〈 0.05]. The ratio of Klebsiella pneumonia infection in DM group was markedly higher than that of non-DM group [53.3% （16/30） vs. 16.7% （5/30）, P 〈 0.01]. The ratio of neutrophile granulocyte in DM group was significantly lower than that of non-DM group [0.85 （0.50-0.98） vs. 0.89 （0.77-0.97）], the duration of persistent fever was obviously longer （days： 21 ± 15 vs. 13 ±7） and the cost of hospitalization was remarkably higher [wan yuan： 2.4 （0.8-18.0） vs. 1.6 （0.4-7.8）] in DM group than those in non DM group （all P 〈 0.05）. Conclusion DM is an important risk factor of PLA, but PLA with DM as an underlying disease is easily to be misdiagnosed, and Klebsiella pneumonia PLA is particularly commonly seen in DM patients.

关 键 词：肝脓肿 肺炎克雷伯杆菌 糖尿病 

分 类 号：R587.1[医药卫生—内分泌]