糖尿病患者不同HbA1c控制水平的肺炎克雷伯菌肝脓肿的临床和影像学表现

摘要

目的 比较糖尿病(DM)患者不同血糖控制水平下肺炎克雷伯菌肝脓肿(KPLA)的临床和影像学表现.方法 146例糖尿病肺炎克雷伯菌肝脓肿(KPLA-DM)患者根据糖化血红蛋白(HbA1c)浓度分为3组(控制好,HbA1c≤7％;控制良好,7％＜HbA1c≤9;控制差,HbA1c＞9％).分别比较3组的一般情况、临床特点、影像学表现及并发症情况.结果 与血糖控制好和良好的患者相比,血糖控制差的患者发病年龄低[平均住院年龄(59.1±13.8)岁],住院时间更长[平均住院时间(23.1士7.6)d];更易合并高脂血症[49例(77.8％)],慢性肾功能不全[12例(19.2％)]等基础疾病;并发症及需积极抢救的临床危象多见;转移性感染多发.影像学表现中,血糖控制差的患者胆管系统积气[18例(28.6％)],肝静脉血栓性静脉炎[20例(31.8％)],肝脓肿产气[26例(28.6％)]发生率增高,差异有统计学意义(P＜0.05).结论 KPLA-DM患者血糖控制差与肝静脉血栓性静脉炎、气体形成和转移性脓肿并发症有关.%Objective To analyze the clinic and imaging features of Klebsiella pneumoniae liver abscess in diabetes mellitus patients with different levels of HbA1c.Methods One hundred and forty-six diabetes patients with KPLA were divided on the basis of their levels of HbA1c into three groups:complete glycemic controlled (HbA1c ≤ 7％);good glycemic controlled (7％ ＜HbA1c≤9 ％) ≤ bad glycemic controlled (HbA1c＞ 9 ％).Compared the patients' characteristics,clinic features,imaging features and complications among each group.Results Compared with patients in groups of complete and good glycemic controlled,patients in group of bad glycemic controlled tend to have younger age at onset[(with an average age of (59.1 ± 13.8)years],longer hospital stay[(with an average stay of (23.1 ± 7.6) day] and more experience complications such as:hyperlipoidemia(49 cases,77.8％),chronic renal failure(12 cases,19.2 ％),life-threatening clinical crisis,and higher infection rate.Patients in bad glycemic controlled also had high risk of biliary pneumatosis(18 cases,28.6 ％),hepatic venous thrombosis (20 cases,31.8 ％) and gas-forming pyogenic liver abscess(26 cases,28.6 ％)(P＜0.05).Conclusion The complications of hepatic venous thrombosis,gas-forming and infection in diabetes patients with KPLA were associated with glycemic uncontrolled.