542例肝脓肿临床分析

发布时间：2017-12-27 17:32

本文关键词：542例肝脓肿临床分析　出处：《南京医科大学学报(自然科学版)》2016年07期 　论文类型：期刊论文

【摘要】：目的 :分析近年肝脓肿(liver abscess,LA)的临床资料,提高该疾病的诊疗水平。方法 :回顾性分析2009年3月—2015年10月在南京医科大学第一附属医院住院的LA患者的一般资料、临床特点、病原学特征及预后。结果 :共收集542例,男女比例1.58∶1,平均年龄(58.4±15.0)岁。常见的基础疾病依次为胆道疾病(41.7%)、糖尿病(37.3%)、心血管系统疾病(33.0%)等。最常见的临床表现是发热(91.7%),最常见的并发症是胸腔积液(24.5%)。γ-谷氨酰转肽酶升高的比例(82.0%)明显高于丙氨酸氨基转移酶(46.6%)、天门冬氨酸氨基转移酶(33.9%)及碱性磷酸酶(47.5%)。脓肿多位于右叶(66.9%),多为单发(75%)、边界不清(64.9%),且以10 cm以内的中、小脓肿为主(89.2%),可有分隔(28.7%)及气腔(9.6%)形成。脓液培养和血培养均以肺炎克雷伯菌阳性最多见,其次为大肠埃希菌。大多数患者经积极治疗后好转出院(92.8%),死亡8例(1.5%)。女性(P=0.018,OR=0.319)、脓肿位于双侧(P=0.017,OR=3.896)、并发败血症(P=0.008,OR=4.390)、腹腔积液(P=0.016,OR=4.340)、感染性休克(P=0.046,OR=5.417)、呼吸衰竭(P=0.004,OR=21.881)、急性胰腺炎(P=0.013,OR=36.281)为预后不良的独立预测因子。结论:通过症状、体征及典型的影像学特征,肝脓肿的诊断并不困难。在积极治疗的同时,尽快评估病情、及时处理并发症可改善预后。
[Abstract]:Objective: to analyze the clinical data of liver abscess (LA) in recent years, and to improve the diagnosis and treatment level of the disease. Methods: the data, clinical characteristics, etiology and prognosis of LA patients who were hospitalized in the First Affiliated Hospital of Nanjing Medical University from March 2009 to October 2015 were retrospectively analyzed. Results: a total of 542 cases were collected, the proportion of men and women was 1.58: 1, the average age was (58.4 + 15) years. The common basic diseases were biliary tract disease (41.7%), diabetes (37.3%), cardiovascular system disease (33%) and so on. The most common clinical manifestation was fever (91.7%), and the most common complication was pleural effusion (24.5%). The proportion of gamma glutamyl transpeptidase increased (82%) was significantly higher than alanine aminotransferase (46.6%), aspartate aminotransferase (33.9%) and alkaline phosphatase (47.5%). Most of the abscesses were located in the right lobe (66.9%), most of them were single (75%), with unclear boundary (64.9%), and mainly 10 (CM), with small and medium-sized abscesses (89.2%). There were septate (28.7%) and air cavity (9.6%). The majority of Klebsiella pneumoniae were found in purulent culture and blood culture, followed by Escherichia coli. Most patients were improved after active treatment (92.8%), and 8 patients died (1.5%). Female (P=0.018, OR=0.319), abscess in the bilateral (P=0.017, OR=3.896), septicemia (P=0.008, OR=4.390) and ascites (P=0.016, OR=4.340), septic shock (P=0.046, OR=5.417), respiratory failure (P=0.004, OR=21.881), acute pancreatitis (P=0.013, OR=36.281) as independent predictors of poor prognosis. Conclusion: the diagnosis of liver abscess is not difficult through symptoms, signs and typical imaging features. At the same time, the prognosis can be improved by assessing the condition as soon as possible and handling the complications as soon as possible.
【作者单位】：南京医科大学第一附属医院感染科;
【基金】：南京市科技计划项目(201104023)
【分类号】：R575.4
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