胆源性细菌性肝脓肿临床及病原学特征  

Clinical and Pathogenic Characteristics of Bacterial Liver Abscess of Biliary Origin

作　　者：林晓宇[1] 朱月永[1] 赖瑞敏[1] 李琛 张婷[1] 郑琦[1] LIN Xiaoyu;ZHU Yueyong;LAI Ruimin;LI Chen;ZHANG Ting;ZHENG Qi(Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China)

机构地区：[1]福建医科大学附属第一医院肝病中心,福州350005

出　　处：《福建医科大学学报》2020年第6期420-424,共5页Journal of Fujian Medical University

基　　金：福建省科技厅社会发展引导性(重点)项目(2019Y0014);福建医科大学启航基金项目(2018QH1052)。

摘　　要：目的探讨胆源性细菌性肝脓肿的临床及病原学特征。方法回顾性分析2014年1月-2018年12月收治的527例细菌性肝脓肿患者的临床资料,其中存在胆道系统疾病的肝脓肿患者(胆源性组)264例,无胆道系统疾病的肝脓肿患者(非胆源性组)263例。比较两组患者的一般资料、实验室检查结果、病原学、影像学特征、治疗方法及结局。结果胆源性肝脓肿患者多为中老年男性,平均年龄(61.71±13.07)岁;基础疾病以糖尿病为主;病原菌以肺炎克雷伯菌最多见,其次是大肠埃希菌,以单一病原菌感染为主,13.26%患者为多种病原菌感染(其中56.76%为肠球菌合并其他革兰阴性菌感染)。非胆源性肝脓肿的病原菌以肺炎克雷伯菌多见,其他病原学少见。单因素及多因素分析提示,胃切除术、胆管手术史、胆管结石是发生大肠埃希菌感染的危险因素,胃切除术病史和胆管结石是发生多种病原菌感染的危险因素。结论胆源性细菌性肝脓肿的病原菌以肺炎克雷伯菌为主,有胆管结石及有胃切除术史的患者选择抗生素时需覆盖大肠埃希菌及肠球菌。Objective To evaluate the clinical and pathogenic characteristics of bacterial liver abscess(BLA)of biliary origin.Methods The clinical characteristics,laboratory test,pathogens,imaging features,treatment methods in 527 patients,including 264 patients with BLA related to biliary tract disease and 263 patients with BLA not related to biliary tract disease,who were admitted to our hospital from January 2014 to December 2018 were retrospectively analyzed.Results BLA related to biliary tract disease patients in this study mostly were elderly male patients,with an average age of(61.71±13.07)years old.The main underlying disease was diabetes,and most cases were caused by Klebsiella pneumoniae,followed by Escherichia coli,and most cases had single pathogen.13.26%of patients had multiple pathogen infections(56.76%of which were enterococci combined with other Gram-negative infections).Most BLA not related to biliary tract disease were caused by Klebsiella pneumoniae,rarely caused by other pathogens.Univariate and multivariate analysis suggested that gastrectomy,history of biliary tract surgery,and bile duct stones were independent risk factors for Escherichia coli infection.History of gastrectomy and bile duct stones were independent risk factors for multiple pathogen infections.ConclusionKlebsiella pneumoniae is still the main pathogen of BLA patients related to biliary tract disease.Treatment for patients with history of bile duct stones and gastrectomy should take the possibility of infection of Escherichia coli and various pathogens into consideration.

关 键 词：胆管系统疾病 细菌性肝脓肿 临床特征 病原学 

分 类 号：R575.4[医药卫生—消化系统] R575.7[医药卫生—内科学]