75例细菌性肝脓肿临床和病原学特点分析

目的回顾性分析细菌性肝脓肿的临床和病原学特点、易发因素及治疗效果,为肝脓肿的临床诊治提供依据。方法选择2010年1月—2013年12月北京地区2所传染病医院确诊的细菌性肝脓肿患者75例,系统性分析其临床资料和病原学特点,探讨肝脓肿发生的危险因素和治疗效果。结果 75例肝脓肿患者中,男55例,女20例,年龄(51.9±16.0)岁。主要临床表现为发热(52.00%)和腹痛(30.67%)。有肝病基础疾病的72例(96.00%),包括肝炎肝硬化45例(62.50%),肝癌23例(31.94%),酒精性肝病3例(4.17%),脂肪肝1例(1.39%)。其中42例(56.00%)伴随其他疾病,包括腹膜炎24例(57.14%),AIDS 13例(30.95%),糖尿病11例(26.19%),高血压10例(23.81%)。脓液和血培养阳性率分别为46.51%(20/43)和24.39%(10/41),肺炎克雷伯菌是主要致病菌(53.33%)。45例经B超或CT引导下穿刺引流并联合抗生素治疗,有效率为88.89%。结论细菌性肝脓肿好发于老年肝病患者,男性居多,临床表现非特异性,病原菌以肺炎克雷伯菌最为常见,经B超或CT引导下穿刺引流并联合抗生素治疗可以取得良好效果。

Clinical and pathogenic characteristics in 75 patients with pyogenic liver abscess

Objective To analyze the clinical and pathogenic characteristics, susceptible factors and treatment efficacy of the patients with pyogenic liver abscess retrospectively, so as to provide evidence for the diagnosis and treatment of pyogenic liver abscess. Methods A total of 75 patients with pyogenic liver abscess treated in two infectious diseases hospitals in Beijing from Jan. 2010 to Dec. 2013 were enrolled in the study. The clinical data and pathogenic characteristics were analyzed, and risk factors and treatment efficacy of pyogenic liver abscess were investigated. Results Of 75 patients with pyogenic liver abscess, 55 were males and 20 were females, and the average age was 51.9 ＆#177;16.0 years old. The major clinical manifestations were fever （52.00%） and ab-dominal pain （30.67%）. Seventy-two （96.00%） patients suffered from underlying liver disease, 45 （62.50%） with liver cirrhosis, 23 （31.94%） with liver cancer, 3 （4.17%） with alcoholic liver disease and 1 （1.39%） with fatty liver. Forty-two （56.00%） patients were complicated by other diseases, 24 （57.14%） with peritonitis, 13 （30.95%） with AIDS, 11 （26.19%） with diabetes and 10 （23.81%） with hypertension. The positive rates of bacteria culture were 46.51%in pyogenic fluids and 24.39%in blood. The most frequent pathogen was Klebsiella pneumonia, accounting for 53.33%. Forty-five patients received both ultrasound B or CT-guided percutaneous drai-nage and antibiotic therapy, with the effectiveness rate of 88.89%. Conclusions Pyogenic liver abscesses mainly occurs in elderly male patients with underlying liver diseases, and has nonspecific clinical manifestations. Klebsiella pneumonia is the most common pathogen. The combination of ultrasound B or CT-guided percutaneous drainage and antibiotic therapy achieves good efficacy.