198例化脓性肝脓肿患者病原学及临床特点分析  

Analysis of the etiology and clinical characteristics of 198 cases with pyogenic liver abscess

作　　者：张颖[1] 郭思 许泼实[1,2] ZHANG Ying;GUO Si;XU Poshi(Department of Clinical Laboratory,People′s Hospital of Henan University/Henan Provincial People′s Hospital,Zhengzhou,Henan 450003,China;Department of Clinical Laboratory,Huazhong Fuwai Hospital,Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]河南大学人民医院/河南省人民医院检验科,河南郑州450003 [2]郑州大学华中阜外医院检验科,河南郑州450003

出　　处：《国际检验医学杂志》2021年第23期2844-2848,共5页International Journal of Laboratory Medicine

基　　金：国家自然科学基金项目(81600944);河南省医学科技攻关计划项目(LHGJ20190808)。

摘　　要：目的探讨河南大学人民医院化脓性肝脓肿患者的临床特点、病原学分布、药敏试验结果及治疗方法,为化脓性肝脓肿的早期诊断和有效治疗提供理论依据。方法回顾性收集河南省人民医院2016年6月至2020年8月收治的198例化脓性肝脓肿患者的临床资料,根据细菌培养结果将肺炎克雷伯菌化脓性肝脓肿(KP-PLA)设为KP-PLA组,大肠埃希菌化脓性肝脓肿(EC-PLA)设为EC-PLA组,分析比较两组患者的临床特点、实验室检查、治疗方法及并发症。结果198例患者中细菌培养阳性99例,肺炎克雷伯菌培养阳性51例,大肠埃希菌培养阳性14例,共培养出细菌115株,KP-PLA组好发糖尿病(χ^(2)=7.292,P=0.007),EC-PLA组常合并肿瘤(χ^(2)=8.483,P=0.004)和肝胆系统手术史(χ^(2)=6.945,P=0.008),脓肿更易复发(χ^(2)=7.729,P=0.005)且常为多发(χ^(2)=11.061,P=0.001),总胆红素水平相对比较高(t=-2.011,P=0.049),肺炎克雷伯菌对大部分抗菌药物均敏感,大肠埃希菌易出现多重耐药,共培养出超广谱β-内酰胺酶菌株14株,大肠埃希菌占78.6%,发现耐碳青霉烯类肠杆菌1株。本研究大多数患者采用抗菌药物联合超声或CT引导下穿刺引流方案治疗。结论化脓性肝脓肿患者部分临床表现不典型,其主要致病菌为肺炎克雷伯菌,其次为大肠埃希菌。抗感染联合穿刺引流是化脓性肝脓肿的一线治疗方法,极大地改善了患者预后,应加强耐药检测,合理应用抗菌药物,避免多药耐药及高毒力菌株产生。Objective To explore the clinical characteristics,pathogenic distribution,drug sensitivity test results and treatment methods of patients with pyogenic liver abscess in the People′s Hospital of Henan University,and provide theoretical basis for the early diagnosis and effective treatment of pyogenic liver abscess.Methods The clinical data of 198 patients with pyogenic liver abscess treated in the People′s Hospital of Henan University from June 2016 to August 2020 were collected retrospectively,according to the results of bacterial culture,Klebsiella pneumoniae pyogenic liver abscess(KP-PLA)was set as KP-PLA group,and Escherichia coli pyogenic liver abscess(EC-PLA)was set as EC-PLA group.The clinical characteristics,laboratory examinations,treatment methods and complications of the two groups of patients were analyzed and compared.Results Among the 198 patients,99 cases were positive for bacterial culture,51 cases were positive for Klebsiella pneumoniae,and 14 cases were positive for Escherichia coli.A total of 115 bacterial strains were cultured.The KP-PLA group was more likely to have diabetes(χ^(2)=7.292,P=0.007).The EC-PLA group often had tumors(χ^(2)=8.483,P=0.004)and history of hepatobiliary surgery(χ^(2)=6.945,P=0.008),and abscesses were more likely to relapse(χ^(2)=7.729,P=0.005)and often multiple(χ^(2)=11.061,P=0.001),the total bilirubin level was relatively high(t=-2.011,P=0.049).Klebsiella pneumoniae was sensitive to most antibacterial drugs,and Escherichia coli was prone to multi-drug resistance,cultured 14 strains of extended-spectrumβ-lactamase-producing strains,and Escherichia coli accounted for 78.6%.One strain of Carbapenem-resistant Enterobacter was found.Most patients in this study were treated with antimicrobial drugs combined with ultrasound or CT guided puncture and drainage.Conclusion Some clinical manifestations of patients with pyogenic liver abscess are atypical.The main pathogenic bacteria is Klebsiella pneumoniae,followed by Escherichia coli.Anti-infection combined with punctu

关 键 词：肝脓肿 临床特征 肺炎克雷伯菌 大肠埃希菌 多药耐药 

分 类 号：R657.33[医药卫生—外科学] R446.5[医药卫生—临床医学]