侵袭性肺炎克雷伯菌肝脓肿综合征的临床特征  

Clinical characteristics of invasive Klebsiella pneumoniae liver abscess syndrome

作　　者：郑烽锋[1] 郑建铭 毛日成 于洁 邱荣仙[1] 许毓贞 张文宏 Zheng Fengfeng;Zheng Jianming;Mao Richeng;Yu Jie;Qiu Rongxian;Xu Yuzhen;Zhang Wenhong(Department of Infectious Diseases,The Affiliated Hospital of Putian University,Putian 351100,China;Department of Infectious Diseases,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]莆田学院附属医院感染科,莆田351100 [2]复旦大学附属华山医院感染科,上海200040

出　　处：《中华传染病杂志》2024年第2期77-83,共7页Chinese Journal of Infectious Diseases

基　　金：国家重点研发计划(2023YFC2308802)。

摘　　要：目的探讨侵袭性肺炎克雷伯菌肝脓肿综合征(IKLAS)发生的影响因素及预后转归。方法纳入2015年1月至2021年2月在复旦大学附属华山医院感染科住院诊断为肺炎克雷伯菌肝脓肿的患者,并根据是否发生IKLAS分为IKLAS组和非IKLAS组,比较两组间临床资料,包括合并糖尿病比例、肝脓肿情况、发热和腹痛等临床症状,以及糖化血红蛋白、血红蛋白等实验室检查结果,统计学比较采用χ^(2)检验或独立样本t检验,采用多因素logistic回归分析发生IKLAS的影响因素。结果纳入75例肺炎克雷伯菌肝脓肿患者,其中IKLAS组55例(73.33%),非IKLAS组20例(26.67%)。IKLAS组合并糖尿病的比例为52.73%(29/55),腹痛发生率为12.73%(7/55),非IKLAS组分别为20.00%(4/20)和45.00%(9/20),差异均有统计学意义(χ^(2)=6.38、7.28,均P<0.05)。肝脓肿多为单发[66.67%(50/75)],且脓肿更易发生在右肝[66.67%(50/75)]。IKLAS组肝脓肿最大直径为(4.58±2.04)cm,小于非IKLAS组的(6.49±3.11)cm,差异有统计学意义(t=2.82,P=0.011)。IKLAS组糖化血红蛋白(8.69%±2.64%比6.18%±1.31%)和血红蛋白[(112.25±22.04)g/L比(100.05±18.59)g/L]均高于非IKLAS组,差异均有统计学意义(t=-4.25、-2.21,均P<0.05)。IKLAS组使用抗菌药物联合脓肿引流的患者比例为38.18%(21/55),非IKLAS组为85.00%(17/20),两组差异有统计学意义(χ^(2)=12.86,P<0.001)。16例患者共有21眼诊断为内源性肺炎克雷伯菌性眼内炎(EKPE),均为IKLAS患者。14例患者行单眼/双眼注药和(或)行玻璃体切割+硅油填充术,13例患者视力明显下降。多因素logistic回归分析示,合并糖尿病是发生IKLAS的独立危险因素[比值比(OR)=5.02,95%可信区间(95%CI)1.01~25.03,P=0.049],而肝脓肿直径大是发生IKLAS的保护因素(OR=0.64,95%CI 0.47~0.86,P=0.003)。结论IKLAS患者腹痛症状更少,合并糖尿病更多。合并糖尿病是发生IKLAS的危险因素,而肝脓肿直径大是其保护因素。EKPE与不良视力预后有关�ObjectiveTo investigate the related factors and prognosis of invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS).MethodsThe in-patients diagnosed with Klebsiella pneumoniae liver abscess in the Department of Infectious Diseases,Huashan Hospital,Fudan University from January 2015 to February 2021 were retrospectively enrolled.The patients were divided into IKLAS group and non-IKLAS group according to whether they had IKLAS or not.The clinical data between the two groups were compared,including the prevalence of diabetes mellitus,the details of liver abscess,clinical symptoms such as fever and abdominal pain,as well as laboratory tests such as glycosylated hemoglobin and hemoglobin.Statistical analysis was performed using chi-square test or independent sample t test.Multivariate logistic regression analysis was used to analyze the factors influencing the occurrence of IKLAS.ResultsA total of 75 patients with Klebsiella pneumoniae liver abscess were enrolled,including 55 patients(73.33%)in the IKLAS group and 20 patients(26.67%)in the non-IKLAS group.Fifty-two point seven three percent(29/55)of the patients had diabetes mellitus and 12.73%(7/55)of the patients had abdominal pain in the IKLAS group,which were 20.00%(4/20)and 45.00%(9/20)in the non-IKLAS group,respectively,and the differences were both statistically significant(χ^(2)=6.38 and 7.28,respectively,both P<0.05).Most of liver abscesses were single(50/75,66.67%),and more likely to occur in the right liver(50/75,66.67%).The maximum diameter of liver abscess in the IKLAS group was(4.58±2.04)cm,which was smaller than that in the non-IKLAS group((6.49±3.11)cm),and the difference was statistically significant(t=2.82,P=0.011).Compared with those in the non-IKLAS group,patients in the IKLAS group had higher glycosylated hemoglobin(8.69%±2.64%vs 6.18%±1.31%)and hemoglobin((112.25±22.04)g/L vs(100.05±18.59)g/L),and the differences were both statistically significant(t=-4.25 and-2.21,respectively,both P<0.05).The proportion of patients using antibiotic

关 键 词：克雷伯菌 肺炎 肝脓肿 眼内炎 侵袭综合征 

分 类 号：R517.6[医药卫生—内科学]