不同免疫状态下细菌性肝脓肿患者临床特点与预后影响因素  

Clinical characteristics and influencing fractors for prognosis of patients with pyogenic liver abscess under different immune status

作　　者：杨惠安 原津津 俞晓玲 官升灿 韩荔芬 YANG Hui-an;YUAN Jin-jin;YU Xiao-ling;GUAN Sheng-can;HAN Li-fen(Department of Infectious Diseases,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China;Department of Pharmacy,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院感染科,福建福州350025 [2]福建医科大学孟超肝胆医院药学部,福建福州350025

出　　处：《中国感染控制杂志》2023年第1期52-58,共7页Chinese Journal of Infection Control

基　　金：福建省卫生健康中青年骨干人才培养项目(2020GGB047);福建省自然科学基金面上项目(2020J011155)。

摘　　要：目的探讨不同免疫状态下细菌性肝脓肿(PLA)患者的临床特点,分析预后不良的影响因素。方法回顾性分析2017年11月—2021年11月福建医科大学孟超肝胆医院收治的104例PLA患者的临床资料。按基础免疫状态分为免疫低下组和免疫正常组,比较两组患者一般情况、实验室及影像学结果、并发症、治疗方案及疾病转归的差异;再根据治疗结果将104例PLA患者分为预后良好组和预后不良组,采用多因素logistic回归分析预后不良的危险因素。结果共纳入患者104例,其中免疫功能正常患者70例,免疫低下患者34例。免疫低下组患者血清降钙素原水平、肺炎克雷伯菌检出率、住院日数高于免疫正常组,且血清清蛋白水平低于免疫正常组(均P<0.05)。两组患者中检出病原菌居前2位的依次是肺炎克雷伯菌、大肠埃希菌。免疫低下组和正常组预后不良(治疗无效包括死亡)率分别为26.5%、7.1%,差异有统计学意义(P<0.05)。两组间临床表现、并发症、治疗方案、住院病死率等其他指标差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,合并免疫功能低下基础病(OR=8.041,P=0.008)、脓肿长径≥10 cm(OR=12.896,P=0.005)、脓毒性休克(OR=7.714,P=0.041)是PLA患者预后不良的独立危险因素。结论PLA患者合并免疫功能低下基础病时感染更重,营养状态更差,并预示住院时间更长,预后不良。对于基础免疫状态低下的PLA患者,需要更积极的治疗策略,并重点监测。Objective To investigate the clinical characteristics of patients with pyogenic liver abscess(PLA)under different immune status,and analyze the influencing factors for poor prognosis.Methods Clinical data of 104 patients with PLA admitted to Meng Chao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2021 were analyzed retrospectively.Patients were divided into immunocompromised group and immunocompetent group based on their basic immune status,and compared in the aspects of general conditions,laboratory and imaging results,complications,treatment plans as well as disease outcomes.According to the treatment results,104 PLA patients were divided into good prognosis group and poor prognosis group.Risk factors for poor prognosis were analyzed with multivariate logistic regression.Results A total of 104 patients were recruited,including 70 immunocompetent patients and 34 immunocompromised patients.Serum procalcitonin level,detection rate of Klebsiella pneumoniae,and length of hospital stay of patients in immunocompromised group were higher than those in immunocompetent group.Serum albumin level was lower than that in immunocompetent group(all P<0.05).The top two pathogens detected in both groups were Klebsiella pneumoniae and Escherichia coli.Poor prognosis rates(ineffective treatment,including death)in immunocompromised group and immunocompetent group were 26.5%and 7.1%respectively,with statistically significant difference(P<0.05).There was no significant difference in clinical manifestations,complications,treatment plans,in-hospital case fatality rates and other indicators between two groups(P>0.05).Multivariate logistic regression analysis showed that combination of immunosuppressive underlying disease(OR=8.041,P=0.008),abscess diameter≥10 cm(OR=12.896,P=0.005),septic shock(OR=7.714,P=0.041)were independent risk factors for poor prognosis of PLA patients.Conclusion When PLA patients is combined with underlying diseases of low immunity,infection is more severe,and the nutritional

关 键 词：肝脓肿 细菌性肝脓肿 病原菌 临床特点 预后 

分 类 号：R575.4[医药卫生—消化系统]