侵袭性肺炎克雷伯菌肝脓肿综合征并发肝静脉血栓一例并文献复习  

One case of invasive Klebsiella pneumonia liver abscess syndrome complicated with hepatic vein thrombosis and review of the literature

作　　者：陈荣荣 丁文森 秦二云 王妮妮 张青[1] 张诚实 冯契靓 刘明[1] 赵云峰 汤长文 Chen Rongrong;Ding Wensen;Qin Eryun;Wang Nini;Zhang Qing;Zhang Chengshi;Feng Qiliang;Liu Ming;Zhao Yunfeng;Tang Changwen(Department of Respiratory Medicine,Punan Branch,Renji Hospital,Shanghai Jiao Tong University,Shanghai 200125,China;Department of Critical Care Medicine,Hai′an People′s Hospital,Jiangsu 226600,China;Department of Respiratory Medicine,Jining No.2 People′s Hospital,Jining,Shandong 272008,China)

机构地区：[1]上海交通大学附属仁济医院浦南分院呼吸内科,上海200125 [2]江苏海安市人民医院重症医学科,海安226600 [3]山东省济宁市第二人民医院呼吸内科,济宁272008

出　　处：《中华肺部疾病杂志(电子版)》2025年第1期115-120,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养计划资助(PWRq2022⁃26);上海市浦东新区卫生系统重点学科建设资助(PWZxk2022⁃24);上海市浦东新区卫生系统临床特色学科建设资助(PWYts2021⁃04);上海市浦东新区卫健委学科带头人课题(PWRd2022⁃12)。

摘　　要：目的分析侵袭性肺炎克雷伯菌肝脓肿综合征(invasive Klebsiella pneumonia liver abscess syndrome,IKLAS)的临床表现、诊断策略及治疗方案,提高IKLAS早期识别和诊治水平。方法选择2024年4月16日我院收治的1例糖尿病并发IKLAS患者的临床资料,分析症状、胸部CT影像学扫描、实验室检测及诊治过程,结合文献复习。结果患者,男,45岁,既往无显著病史,因咳嗽咳痰、发热3周,加重伴胸痛3 d入院。胸部CT提示两肺多发结节,肺门及纵隔淋巴结肿大,肝右叶低密度影;完善肺部增强CT扫描提示肺部多发结节样病灶较前明显变大,伴空洞、血管滋养征,片状浸润、渗出影较前进展,纵隔淋巴结肿大;上腹部增强CT扫描提示肝片状低密度灶,考虑肝脓肿伴肝静脉血栓;血培养、肺泡灌洗液宏基因组二代测序(metagenomic next⁃generation sequencing,mNGS)提示肺炎克雷伯菌(Klebsiella pneumonia,KP),拉丝实验阳性,随机血糖21.00 mmol/L,糖化血红蛋白12.9%,考虑糖尿病并发IKLAS。抗生素升级为亚胺培南西司他丁联合头孢哌酮钠舒巴坦钠,治疗后症状改善,体温恢复正常,复查CT扫描提示肺部及肝脏病灶明显吸收,最终好转出院。结论糖尿病并发IKLAS的临床表现隐匿且进展迅速,易被忽视,导致治疗延误。糖尿病并发肝脓肿患者,应高度警惕肺炎克雷伯菌感染的可能性,注意常见的侵袭部位。早期诊断、及时应用敏感抗生素,必要脓液引流是改善预后关键。Objective To investigate the clinical manifestations,diagnostic strategies,and treatment options for invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS),aiming to enhance clinicians′ability to recognize and manage IKLAS at an early stage.Methods A case admitted to our hospital on April 16,2024 was selected on the clinical data of a diabetic patient complicated with IKLAS,including symptoms,imaging studies,laboratory tests,and treatment process,supplemented by a review of relevant literature.Results A 45⁃year⁃old male with no significant medical history was admitted due to a 3⁃week history of cough,sputum,and fever,which worsened with chest pain over the past 3 days.Chest CT revealed multiple pulmonary nodules,hilar and mediastinal lymphadenopathy,and a hypodense lesion in the right lobe of the liver.Subsequent contrast⁃enhanced chest CT showed enlargement of the pulmonary nodules with cavitation,vascular feeding signs,and progression of patchy infiltrates and effusions,along with mediastinal lymphadenopathy.Contrast⁃enhanced abdominal CT indicated a hypodense hepatic lesion,suggesting liver abscess with hepatic vein thrombosis.Blood cultures and bronchoalveolar lavage metagenomic next⁃generation sequencing(mNGS)both identified Klebsiella pneumoniae,with a positive string test.Random blood glucose was 21.00 mmol/L,and glycated hemoglobin was 12.9%,leading to a diagnosis of diabetes complicated by IKLAS.After upgrading antibiotic therapy to imipenem⁃cilastatin combined with cefoperazone⁃sulbactam,the patient′s symptoms significantly improved,body temperature normalized,and follow⁃up CT showed marked resolution of pulmonary and hepatic lesions,resulting in discharge with improvement.Conclusion The clinical manifestations of diabetes complicated by IKLAS are insidious and rapidly progressive,often leading to delayed diagnosis and treatment.For diabetic patients with liver abscess,a high suspicion of Klebsiella pneumoniae infection should be maintained,with attention to common sites of i

关 键 词：肺炎克雷伯菌 肺炎克雷伯菌肝脓肿侵袭综合征 糖尿病 肝静脉血栓 文献复习 

分 类 号：R563[医药卫生—呼吸系统]