2型糖尿病合并细菌性肝脓肿患者临床特征分析  

Clinical feature of patients with bacterial liver abscess and concurrent underlying type 2 diabetes mellitus

作　　者：伊芬秀 伊芬锦 娄仲雷 Yi Fenxiu;Yi Fenjin;Lou Zhonglei(Department of Endocrinology,Second People's Hospital,Xining 810003,Qinghai Province,China)

机构地区：[1]西宁市第二人民医院内分泌科,810003 [2]西宁市第二人民医院心内科,810003 [3]青海大学医学院附属医院感染性疾病科

出　　处：《实用肝脏病杂志》2024年第6期935-938,共4页Journal of Practical Hepatology

基　　金：青海省卫生健康委科研项目(编号:2023-wjzdx-95)。

摘　　要：目的探讨2型糖尿病(T2DM)合并细菌性肝脓肿(BLA)患者的临床特征,总结治疗经验。方法2021年5月~2023年10月我院诊治的102例BLA患者,其中合并T2DM者41例。行血培养或脓液培养,进行感染细菌鉴定。给予抗生素联合穿刺抽脓或置管引流治疗。采用荧光免疫层析法检测血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)和淀粉样蛋白A(SAA),采用胶乳免疫比浊法检测血清D-二聚体(D-D)。结果合并T2DM组合并高血压和呼吸道感染比例分别为51.2%和36.6%,均显著高于未合并组(分别为18.0%和8.2%,P<0.05);合并T2DM组血清IL-6、CRP、PCT和SAA水平分别为344.3(155.0,511.9)pg/ml、180.9(82.1,270.7)mg/L、8.6(5.7,10.6)μg/L和19.3(14.2,25.5)mg/L,显著高于BLA组【分别为195.5(136.6,274.1)pg/ml、124.8(52.5,190.4)mg/L、2.2(1.4,2.7)μg/L和14.5(12.6,20.1)mg/L,P<0.05】;合并T2DM组肺炎克雷伯杆菌感染率为78.0%,显著高于BLA组的57.4%(P<0.05);合并T2DM的BLA患者置管引流和抗菌药物治疗时间分别为6(3,10)d和13(5,20)d,均显著长于BLA组【分别为4(2,8)d和10(4,16)d,P<0.05】;除合并T2DM组死亡1例(2.4%)外,两组均治愈。结论合并T2DM的BLA患者可能更多地存在呼吸道感染,以肺炎克雷伯杆菌感染为主,但经抗感染和肝穿刺抽脓或置管引流治疗,总体疗效较好。Objective The aim of this study was to summarize the clinical feature of patients with bacterial liver abscess(BLA)and concurrent underlying type 2 diabetes mellitus(T2DM).Methods 102 consecutive patients with BLA,of which,with concurrent underlying T2DM in 41 cases,were encountered in our hospital between May 2021 and October 2023,and all received antibiotics and intra-purulent cavity catheterization and pus drainage.Blood and/or pus bacterial culture and identification were conducted.Serum interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT),amyloid A(SAA)and D-dimer(D-D)levels were detected.Results Concurrent blood hypertension and pulmonary infections in patients with BLA and T2DM were 51.2%and 36.6%,both significantly higher than 18.0%and 8.2%(P<0.05)in those with BLA without T2DM;serum IL-6,CRP,PCT and SAA levels in patients with BLA and T2DM were 344.3(155.0,511.9)pg/ml,180.9(82.1,270.7)mg/L,8.6(5.7,10.6)μg/L and 19.3(14.2,25.5)mg/L,all significantly higher than[195.5(136.6,274.1)pg/ml,124.8(52.5,190.4)mg/L,2.2(1.4,2.7)μg/L and 14.5(12.6,20.1)mg/L,respectively,P<0.05]in those with BLA;Klebsiella Pneumoniae infection rate in patients with BLA and T2DM was 78.0%,much higher than 57.4%(P<0.05)in patients with BLA;catheterization for pus drainage and antibiotics therapy in patients with BLA and T2DM lasted for 6(3,10)d and 13(5,20)d,both much longer than[4(2,8)d and 10(4,16)d,P<0.05]in patients with BLA;all but one patient(2.4%)with BLA and T2DM who died recovered.Conclusion Pulmonary and Klebsiella pneumoniae infection is more common in patients with BLA and concurrent underlying T2DM,and antibiotics and intra-purulent cavity catheterization for pus drainage is efficacious with a satisfactory outcomes.

关 键 词：细菌性肝脓肿 2型糖尿病 病原菌 炎症因子 临床特征 

分 类 号：R575.4[医药卫生—消化系统] R587.1[医药卫生—内科学]