细菌性肝脓肿合并败血症临床特征及危险因素分析  

Clinical characteristics and risk factors of bacterial liver abscess complicated with septicemia

作　　者：刘瑶[1,2] 邵宇云 史萍 韩亚萍 蒋龙凤 李军[1] 

机构地区：[1]江苏省南京医科大学第一附属医院感染科,210029 [2]江苏大学附属医院消化科

出　　处：《中华临床感染病杂志》2017年第2期125-129,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：江苏省自然科学基金青年基金（BK20161059）;中国肝炎防治基金会一天晴肝病研究基金（CFHPC20132071）;江苏省卫生厅医学创新团队与领军人才培养基金（13201121）

摘　　要：目的 分析细菌性肝脓肿合并败血症的临床特征、危险因素、临床结局等,为预防病情进展提供依据.方法 收集本院2011年1月1日至2015年12月31日住院确诊的细菌性肝脓肿合并败血症52例为病例组,随机选择相同时间内住院的无败血症的细菌性肝脓肿患者52例为对照组,分析比较病例组和对照组患者的临床、实验室、影像学及临床转归等指标.Logistic回归分析细菌性肝脓肿合并败血症的临床特征及危险因素.结果 与对照组比较,病例组患者合并糖尿病、合并恶性肿瘤、出现低蛋白血症、肾功能不全、黄疸、伴高血糖水平、多发脓肿及脓肿直径≥10cm的比例均显著升高（P＆lt;0.05或＆lt;0.01）.病原学方面,细菌性肝脓肿合并败血症患者中血培养以肺炎克雷伯杆菌最多见（63.3%）,其次是大肠埃希菌（16.7%）.单因素Logistic回归分析显示合并糖尿病（OR=2.200,95%CI 1.042~4.646）、合并恶性肿瘤（OR=3.667,95%CI 1.023~13.143）、低蛋白血症（OR=2.800,95%CI 1.009~7.774）、肾功能不全（OR=3.167,95%CI 1.265~7.929）、高血糖水平（OR=3.400,95%CI 1.254~9.216）、多发脓肿（OR=2.667,95%CI 1.043~6.815）及脓肿直径≥10cm（OR=5.000,95%CI 1.096~22.820）是细菌性肝脓肿合并败血症的危险因素,多因素Logistic回归分析显示,脓肿直径≥10cm（OR=14.016,95%CI 1.354~145.070）是细菌性肝脓肿合并败血症的独立危险因素.结论 败血症是细菌性肝脓肿常见的合并症,临床上应根据其相关的危险因素采取切实有效的预防和控制措施.Objective To investigate the clinical characteristics and risk factors of bacterial liver abscess （BLA） complicated with septicemia.Methods Fifty two BLA patients complicated with septicemia admitted in our hospital from January 2011 to December 2015 were retrospectively reviewed;and 52 cases of BLA without septicemia admitted at the same period were randomly selected as control group.The clinical manifestations, laboratory and radiographic findings, clinical outcome of these patients were analyzed.Logistic regression analysis was used to study the clinical features and risk factors of BLA complicated with septicemia.Results Compared to the control group, the BLA with septicemia group had higher prevalence rates in diabetes mellitus, malignant tumors, jaundice, albumin 〈35 g/L, BUN≥8.2 mmol/L, hyperglycemia, multiple abscesses and abscesses size ≥10 cm（P〈0.05 or 〈0.01）.The blood culture showed that K.pneumoniae（63.3%） was the most commonly isolated pathogen, followed by E.coli（16.7%）.Univariate analysis revealed that diabetes mellitus（OR=2.200,95%CI 1.042-4.646）, malignant tumors （OR=3.667,95%CI 1.023-13.143）, albumin 〈35 g/ L（OR=2.800,95%CI 1.009-7.774）, BUN≥8.2 mmol/L（OR=3.167,95%CI 1.265-7.929）, hyperglycemia（OR=3.400,95%CI 1.254-9.216）, multiple abscesses（OR=2.667,95%CI 1.043-6.815）, abscesses size≥10 cm （OR=5.000,95%CI 1.096-22.820） were positively associated with bacterial liver abscess complicated with septicemia.Multivariate Logistic regression showed that abscesses size≥10 cm （OR=14.016,95%CI 1.354-145.070） was an independent risk factor for complication of with septicemia.Conclusion septicemia is a common complication for bacterial liver abscess, clinically effective measures shauld be taken to prevent and control risk factors associated with septicemia.

关 键 词：肝脓肿 出血性败血症 疾病特征 危险因素 病原学 

分 类 号：R575.4[医药卫生—消化系统]