糖尿病并细菌性肝脓肿临床特征研究

摘要

Objective To summarize the clinical features and treatment experience in patients with diabetes accompanied companied with gynogenic hepatic abscess (DPHA). Methods The medical records of the patients with DHPA or non-diabetic gynogenic hepatic abscess (NDPHA) discharged during March 2002 and December 2010 from our hospital were analyzed retrospectively. Results A total of 22 cases of pyogenic hepatic abscess were admitted during the same period, of which, 11 cases was from DPHA group, 11 cases was from NDPHA group. Right upper quadrant pain, jaundice, hepatomegaly , fever days and white blood cell count had no statistically significant difference between DPHA group and NDPHA group (P >0.05). Serum albumin and ALT in DPHA group compared with the NDPHA homologous had significant difference (P < 0.01). DPHA group lesion number and size of lesion were higher than that of NDPHA group. DPHA group had 4 cases of Kiebsiella isolated, E. Coli in 3 cases; E. Coli in 3 cases of NDPHA, but no Klebsiella isolation. Surgical drainage, percutaneous drainage and conservative treatment were preformed in DPHA and NDPHA groups. DPHA group was given Insulin to control blood glucose. There were 7 cases of wound infection and 2 cases of abdominal infection in DPHA group, 3 cases of wound infection in NDPHA group. There was 6 cases of cure, 5 cases of improvement, no death in the two groups. Plasma demand, administration time of Antibiotics, length of stay and medical costs were higher in DPHA group than in NDPHA group (P<0.05). Conclusion Compared with NDPHA group, hypoproteinemia, complications and liver enzyme abnormalitiesal are more obvious in DHPA group, but comprehensive treatment can result in satisfactory prognosis.%目的 探讨糖尿病并细菌性肝脓肿(diabetes companied with pyogenic hepatic abscess,DPHA)的临床特点,并总结诊治经验.方法 回顾分析2002年3月～2010年12月我院收治的细菌性肝脓肿(pyogenic hepatic abscess,PHA)22例的临床资料.结果 我院同期收治PHA 22例,其中DPHA及非糖尿病细菌性肝脓肿(nondiabetes companied with pyogenic hepatic abscess,NDPHA)各11例,分别为DPHA组和NDPHA组.两组右上腹痛、黄疸、肝大、发热天数、血白细胞比较差异均无统计学意义(P＞0.05)；血白蛋白、丙氨酸转氨酶比较差异有统计学意义(P＜0.01).DPHA组平均每例病灶个数及大小均高于NDPHA组.脓液细菌培养DPHA组克雷伯杆菌4例,大肠杆菌3例；NDPHA组大肠杆菌3例.两组均予手术和穿刺引流、保守治疗,DPHA组同时使用胰岛索控制血糖.DPHA组发生切口感染7例、腹腔感染2例,NDPHA组发生切口感染3例.两组均治愈6例,好转5例,皆无死亡病例,但DPHA组血浆需求量、抗生素使用时间、平均住院日和医疗费用均高于NDPHA组,差异有统计学意义(P＜0.05).结论 DHPA较NDPHA低蛋白血症和肝酶异常更加明显,且并发症多,但经综合治疗预后尚好.