细菌性肝脓肿并发脓毒症的临床特征  

Clinical characteristics of sepsis caused by pyogenic liver abscess

作　　者：张碧莹[1,2] 路明[2,3] 林菲[1,2] 贾莹[1,2] 梁京津[1,2] 邓忠华[1,2] 李璐[1,2] ZHANG Bi-ying;LU Ming;LIN Fei;JIA Ying;LIANG Jing-jin;DENG Zhong-hua;LI Lu(Department of Infectious Disease,Peking University Third Hospital,Beijing 100191,China;Infectious Disease Center,Peking University Third Hospital,Beijing 100191,China;Department of Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院感染疾病科,北京100191 [2]北京大学第三医院感染疾病科中心,北京100191 [3]北京大学第三医院呼吸与危重症医学科,北京100191

出　　处：《中国临床药理学杂志》2023年第3期307-311,共5页The Chinese Journal of Clinical Pharmacology

基　　金：北京医卫健康公益基金会资助项目(YWJKJJHKYJJ-B17807)。

摘　　要：目的 分析细菌性肝脓肿(PLA)并发脓毒症患者的临床特征,探索早期预测PLA并发脓毒症的生物标志物。方法 回顾性分析肝脓肿患者的病例资料,并根据序贯器官衰竭评分将患者分为脓毒症组和非脓毒症组。分析2组患者的症状、实验室检查、病原学和预后对PLA的影响。通过受试者工作特性曲线探索血降钙素原(PCT)对肝脓肿进展为脓毒症早期的预测价值。结果 最终脓毒症组和非脓毒症组分别纳入57和96例。脓毒症组和非脓毒症组的合并基础胆道疾病比例分别为24.56%和11.46%,外周血白细胞水平分别为13.87×10^(9)和11.08×10^(9)·L^(-1),就诊时PCT分别为12.06和0.31 ng·mL^(-1),最高值PCT分别为13.89和0.36 ng·mL^(-1),并发脓毒症休克导致的病死率分别为10.53%和0,差异均有统计学意义(均P<0.05)。脓毒症组患者并发肝外转移灶(包括肺脓肿、眼内炎)比例高于非脓毒症组,病原体为肺炎克雷伯菌比例更高,但差异均无统计学意义(均P>0.05)。就诊时及住院后最高值PCT可作为预测PLA患者进展为脓毒症的指标,曲线下面积分别为0.75(95%CI=0.65~0.85)和0.79(95%CI=0.70~0.88),最佳截断值为8.995 ng·mL^(-1)。结论 PLA合并胆道疾病患者更容易并发脓毒症,当PCT≥8.995 ng·mL^(-1)时,预示患者会并发脓毒症,病死率明显增加。Objective To analyze the clinical characteristics of pyogenic liver abscess(PLA) with sepsis, and explore biomarkers for early prediction of PLA with sepsis. Methods A retrospective study of the patients with pyogenic liver abscess was conducted, and the patients were divided into sepsis group and non-sepsis group according to sequential organ failure score. The demographic characteristics, clinical features, laboratory and imaging findings, as well as microbiologic findings and prognosis were analyzed. The predictive value of procalcitonin(PCT) in the early stage of PLA with sepsis was explored through the receiver operating characteristic curve. Results Finally, the sepsis group and non-sepsis group were 57 and 96 cases. The proportions of patients with basic biliary diseases in sepsis group and non-sepsis group were 24.56% and 11.46%, peripheral white blood cells were 13.87×10^(9) and 11.08×10^(9)·L^(-1), levels of PCT at the first visit were 12.06 and 0.31 ng·mL^(-1),the highest levels of PCT were 13.89 and 0.36 ng·mL^(-1), the mortality rates due to septic shock were 10.53% and 0, the differences were statistically significant between two groups(all P< 0. 05). The proportions of patients with extrahepatic migration(including lung abscess and endophthalmitis) insepsis group was higher than that in non-sepsis group, and the ratio of pathogen asKlebsiella pneumoniaewas higher,but the differences were not statistically significant(allP> 0. 05). The PCT value at the first time of visit hospital andthe highest value after hospitalization can be used as an indicator to predict the progress of PLA with sepsis. Area underthe curve was 0. 75(95% CI = 0. 65-0. 85) and 0. 78(95% CI = 0. 70-0. 88) respectively, and the best cut-offvalue was 8. 995 ng·mL^(-1).Conclusion PLA patients with biliary tract diseases are more likely to develop sepsis.PCT≥8. 995 ng·mL^(-1)indicates that the PLA patients will be progressed to sepsis,and the mortality will increasesignificantly.

关 键 词：细菌性肝脓肿 肝脓肿 脓毒症 降钙素原 临床特征 

分 类 号：R97[医药卫生—药品]