社区获得性化脓性肝脓肿的单中心回顾性临床流行病学研究  

Retrospective single center epidemiological study of community acquired pyogenic liver abscess

作　　者：王术 郑旭婷[1] 田素飞[2] 褚云卓[2] 陈佰义[1] Wang Shu;Zheng Xuting;Tian Sufei;Chu Yunzhuo;Chen Baiyi(Department of Infectious Diseases,First Hospital of China Medical University,Shenyang 110000,China;Department of Laboratory,First Hospital of China Medical University,Shenyang 110000,China;Department of Respiratory Diseases,Yingkou Central Hospital,Liaoning Province 115000,China)

机构地区：[1]中国医科大学附属第一医院感染科,沈阳110000 [2]中国医科大学附属第一医院检验科,沈阳110000 [3]辽宁省营口市中心医院呼吸科,115000

出　　处：《中华传染病杂志》2020年第5期288-293,共6页Chinese Journal of Infectious Diseases

基　　金：辽宁省自然科学基金(2019-MS-383)。

摘　　要：目的:分析社区获得性化脓性肝脓肿(community acquired pyogenic liver abscess,CA-PLA)的流行病学变化趋势,为其早识别、早诊断和合理抗感染治疗等提供借鉴。方法:回顾性分析中国医科大学附属第一医院2011年1月至2017年12月住院的CA-PLA患者体征和治疗结果,将其基础疾病、发病症状按照年份分组,分析发病特征变化趋势,根据患者是否有胆道基础疾病,分别分析其病原学特征。统计学方法采用χ^2检验。结果:共纳入1063例CA-PLA患者,根据患者基础疾病情况按年份进行趋势分析:CA-PLA收治患者有逐年增加趋势;既往有胆道基础疾病患者的比例从2011年的17.3%(19/110)降至2017年的7.3%(14/191),差异有统计学意义(χ^2=13.648,P=0.034);糖尿病患者占比高但并没有逐年增加的趋势,7年来维持在31.6%~46.5%。274例(25.8%)患者伴有肝外表现。病原学阳性445例,其中单一肺炎克雷伯菌感染371例(83.4%);无胆道基础疾病者以单一肺炎克雷伯菌为主要致病菌[91.6%(362/395)],有胆道基础疾病者仅占18.0%(9/50),其他依次为大肠埃希菌[32%(16/50)]感染和混合感染[18%(9/50)];基于临床定义的高毒力肺炎克雷伯菌对二代及以上头孢菌素敏感率≥97.5%,对碳青霉烯类抗菌药物敏感率为100.0%。患者总体预后良好,其中1049例治愈或好转出院,6例自动出院,8例死亡。结论:大部分CA-PLA患者没有胆道基础疾病,50%以上的患者无糖尿病病史,且绝大多数病原体为肺炎克雷伯菌,对抗菌药物相对敏感。Objective To investigate the epidemiological characteristics of community acquired pyogenic liver abscess(CA-PLA)as a reference for its early identification,early diagnosis and rational antibacterial treatment.Methods A single center retrospective study was carried out in patients with CA-PLA hospitalized in First Hospital of China Medical University from January 2011 to December 2017.The symptoms,signs and treatment results were concluded.The underlying diseases and onset symptoms of the cases were grouped by year,and the change trend of the disease characteristics was analyzed.The etiology results were grouped according to whether the patients had underlying diseases of biliary tract,and the etiology characteristics were analyzed.Statistical analysis was performed by using chi-square test.Results A total of 1063 CA-PLA cases were included in this study.The analysis on underlying diseases grouped by year showed that the number of patients admitted to the hospital increased annually,and the percentage of patients with underlying hepatobiliary diseases decreased from 17.3%(19/110)in 2011 to 7.3%(14/191)in 2017,the difference was statistically significant(χ2=13.648,P=0.034),while that of patients with diabetes mellitus kept high at 31.6%to 46.5%in the past seven years without increasing trend.There were 274 patients(25.8%)with extrahepatic manifestations.Totally 445 cases were microbiologically diagnosed,among which single Klebsiella pneumoniae infection was found in 371 cases(83.4%).Klebsiella pneumoniae was the leading pathogen in patients without underlying hepatobiliary diseases(91.6%,362/395),in contrast to 18.0%(9/50)in patients with underlying hepatobiliary diseases.The other pathogens were Escherichia Coli(32.0%,16/50)and mixed infection(18.0%,9/50).The susceptibility rate to second generation and above cephalosporins of clinically defined hypervirulent Klebsiella pneumoniae was≥97.5%,and that to carbapenems was 100.0%.Most patients had good prognosis,and 1049 cases were cure or improvement discharged,si

关 键 词：肝脓肿 流行病学 肺炎克雷伯菌 

分 类 号：R575.4[医药卫生—消化系统]