老年糖尿病合并细菌性肝脓肿患者的临床特征分析  

Analysis of clinical characteristics of elderly patients with diabetes mellitus complicated with bacterial liver abscess

作　　者：赵博 谢桂娟 Zhao Bo;Xie Guijuan(Department of Gastroenterology,Second People's Hospital of Wuxi City/Wuxi Clinical College of Nantong University,Wuxi,Jiangsu,214000,P.R.China;Department of Respiratory and Critical Care 9 Second People's Hospital of Wuxi City/Wuxi Clinical College of Nantong University,Wuxi,Jiangsu,214000,P.R.China)

机构地区：[1]南通大学无锡临床学院,无锡市第二人民医院消化内科,江苏无锡214000 [2]南通大学无锡临床学院,无锡市第二人民医院呼吸与危重症学科,江苏无锡214000

出　　处：《老年医学与保健》2022年第1期163-167,177,共6页Geriatrics & Health Care

基　　金：南通大学临床医学专项项目(2019LY045)。

摘　　要：目的探讨分析老年糖尿病合并细菌性肝脓肿(pyogenic liver abscess,PLA)患者的临床特征。方法回顾性分析2016年11月—2021年11月无锡市第二人民医院消化内科收治的细菌性肝脓肿的70例老年患者的临床资料,按照有无2型糖尿病分为糖尿病组(36例)和非糖尿病组(34例)。分析并比较2组的一般临床资料、基础疾病、相关实验室结果、影像学表现、并发症、病原学培养结果、治疗以及转归。结果糖尿病组白细胞数、中性粒细胞比率、糖化血红蛋白及总胆红素水平均高于非糖尿病组(P<0.05)。对于直径> 2cm的肝脓肿,糖尿病组(88.9%)要明显多于非糖尿病组(32.4%)(P<0.01)。与非糖尿病组比较,糖尿病组有更多患者被检测出病原体,但差异无统计学意义(P=0.05),且检出病原体的种类也更多。在2组中,肺炎克雷伯菌(klebsiella pneumonia,KP)都是最主要的致病菌。在糖尿病组中并发肺炎明显更多见(P<0.05)。2组接受肝脓肿引流的比例无差别。结论糖尿病合并细菌性肝脓肿的老年患者的症状和体征不典型,应避免漏诊,他们可被检出更高水平的白细胞、更大体积的肝脓肿、更多种类的病原体,合并肺炎的风险也更大。KP是主要致病菌。积极的抗生素治疗联合经皮穿刺有较好的临床疗效。Objective To analyze the clinical characteristics of elderly patients with diabetes mellitus complicated with bacterial liver abscess. Methods Clinical data of 70 elderly patients with bacterial liver abscess treated in the Department of Gastroenterology of Second People’s Hospital of Wuxi City from November2016 to November2021 were analyzed retrospectively. They were divided into diabetes group(36 cases)and non-diabetic group(34 cases)according to whether they had type2 diabetes. The general clinical data,basic diseases,relevant laboratory results,imaging findings,complications,etiological culture results,treatment and prognosis of the two groups were analyzed and compared. Results The number of white blood cells,neutrophil ratio,glycosylated hemoglobin and total bilirubin levels of the diabetic group were higher than those of the non-diabetic group(P< 0.05). The number of liver abscesses larger than2 cm in the diabetic group(88. 9%)was significantly more than that in the non-diabetic group(32.4%)(P< 0.01). Compared with the non-diabetic group,more patients in the diabetic group were detected pathogens,but the difference was not statistically significant(P= 0. 05),and there were more types of detected pathogens. In both groups,Klebsiella pneumonia(KP)was the most important pathogen. Pneumonia was significantly more common in the diabetes group(P< 0.05). There was no difference in the proportion of patients receiving liver abscess drainage between the two groups. Conclusion The symptoms and signs of elderly patients with diabetes mellitus complicated with bacterial liver abscess are not typical,and missed diagnosis should be avoided. They can be detected with higher levels of white blood cells,larger liver abscesses,more kinds of pathogens,and a greater risk of pneumonia. KP is the main pathogen. Active antibiotic therapy combined with percutaneous puncture has a good clinical effect.

关 键 词：老年 糖尿病 细菌性肝脓肿 临床特征 

分 类 号：R587.2[医药卫生—内分泌] R575.4[医药卫生—内科学]