糖尿病患者不同HbA1c控制水平的肺炎克雷伯菌肝脓肿临床和超声特征  

The clinical and ultrasound features of Klebsiella pneumoniae liver abscess in diabetes mellitus patients with different levels of HbA1c

作　　者：施静[1] 丁炎[1] 周昊[1] 吴鹏西[1] 朱巧英[1] 周锋盛[1] 蒋骁[1] 

机构地区：[1]南京医科大学附属无锡人民医院超声医学科,江苏无锡214023

出　　处：《重庆医学》2016年第30期4222-4225,共4页Chongqing medicine

摘　　要：目的比较糖尿病(DM)患者不同血糖控制水平下肺炎克雷伯菌肝脓肿(KPLA)的临床和超声特征。方法 146例糖尿病肺炎克雷伯菌肝脓肿(KPLA-DM)患者根据糖化产物血红蛋白A1c(HbA1c)水平分为3组(控制好,HbA1c≤7%;控制良好,7%<HbA1c≤9%;控制差,HbA1c>9%)。分别比较3组的一般情况、临床特点、超声特征及并发症情况。结果与血糖控制好和良好的患者相比,血糖控制差的患者发病年龄低、住院时间更长(P<0.05);更易合并高脂血症、慢性肾功能不全等基础疾病(P<0.05);并发症及需积极抢救的临床危象多见;转移性感染多发(P<0.05)。KPLA-DM可呈特征性的片状、团块状增强回声超声图像,血糖控制差的患者胆道系统积气、肝静脉血栓形成发生率较其他两组明显增高(P<0.05)。结论 KPLA-DM超声图像具有特征性,超声观察到的胆道系统积气及肝静脉血栓形成与KPLA-DM患者血糖控制差相关,提示可能存在转移性感染等并发症。Objective To compare the clinical and ultrasound features of Klebsiella pneumoniae liver abscess（KPLA）in diabetes mellitus（DM）patients with different levels of HbA1 c.Methods Totally 146 patients with diabetes mellitus of Klebsiella pneumoniae liver abscesses（KPLA-DM）were divided into three groups on the basis of their levels of HbA1c：complete glycemic controlled（HbA1c≤7%）;good glycemic controlled（7%HbA1c≤9%）;bad glycemic controlled（HbA1c9%）.The patients′characteristics,clinical features,ultrasound features and complications among the three groups were compared.Results Compared with patients in complete glycemic controlled group and good glycemic controlled group,patients in bad glycemic controlled group had lower onset age and longer length of hospital stay（P〈0.05）,are more susceptible to underlying diseases such as hyperlipoidemia and chronic renal failure（P〈0.05）,had more life-threatening clinical crisis,and had higher infection rate（P〈0.05）.KPLADM could be characterized by ＂patchy,mass like enhancement echo＂ ultrasound image.Patients in bad glycemic controlled group also had higher risk of biliary pneumatosis,hepatic venous thrombosis and gas-forming pyogenic liver abscess than other two groups（P〈0.05）.Conclusion The ultrasound image of KPLA has characteristics.The occurrence of hepatic venous thrombosis and gasforming observed by ultrasound is associated with bad glucose control in KPLA-DM patients,which suggests that there may be other complications such as metastatic infection.

关 键 词：糖尿病 糖化血红蛋白 肺炎克雷伯菌肝脓肿 超声 

分 类 号：R587.1[医药卫生—内分泌] R445.1[医药卫生—内科学] R575.4[医药卫生—临床医学]