产气荚膜梭菌感染引起肝脓肿和严重溶血性贫血1例及文献复习

探讨糖尿病患者产气荚膜梭菌(Cp)感染导致肝脓肿、溶血性贫血的临床特点及诊疗经过，提高对此类患者的认识和诊治水平。分析某院2022年8月收治的1例Cp感染引起肝脓肿、溶血性贫血、血流感染、多脏器功能衰竭的糖尿病患者临床资料，结合相关文献进行回顾性分析。共检索到19篇外文文献，结合本研究1例，共纳入20例患者。男性、女性各10例，平均年龄70.7岁，合并糖尿病12例。患者临床表现缺乏特异性，所有患者均有不同程度的溶血性贫血。死亡17例(85.0%),从就诊到死亡平均时间23.84 h,其中14例(82.4%)患者在明确病原菌诊断前已死亡，11例(64.7%)患者在入院≤8 h因抢救无效死亡；存活患者仅3例，均在疾病早期得到病原学结果，2例患者早期行肝脓肿穿刺引流术，另1例患者治疗过程中肝脓肿自行破溃至肝包膜下，肿块缩小。Cp感染肝脓肿合并溶血性贫血进展迅速，早期病死率极高，故早期诊断十分重要。怀疑Cp感染时，应立即行穿刺液/血液革兰染色，或经宏基因组二代测序(mNGS)等检测手段明确病原诊断，以期通过早期调整敏感抗菌药物和清除感染病灶改变患者生存结局。

Liver abscess and severe hemolytic anemia infected by Clostridium perfringens: a case report and literature review

To explore the clinical characteristics, diagnosis and treatment process of liver abscess and hemolytic anemia caused by Clostridium perfringens (Cp) infection in diabetes patients, and improve the awareness, diagnosis and treatment of patients. Clinical data of a diabetes patient with liver abscess, hemolytic anemia, bloodstream infection and multiple organ failure caused by Cp infection in a hospital in August 2022 were analyzed. Retrospective analysis of the data was conducted in combination with relevant literatures. A total of 19 English literatures were retrieved. Combined with the case in this study, 20 patients were included in the analysis, 10 were males and 10 were females, with an average age of 70.7 years, 12 patients complicated with diabetes. Clinical manifestations of the patients lacked specificity, and all patients had varying degrees of hemolytic anemia. Seventeen patients (85.0%) died, with an average time of 23.84 hours from seeking medical advice to death. Fourteen of them (82.4%) died before a clear pathogenic diagnosis was made, and 11 (64.7%) died within 8 hours of admission due to ineffective rescue efforts. There were only 3 survived patients, all of whom had obtained pathogenic results at the early stage of the disease: two patients underwent liver abscess puncture and drainage at the early stage, while the other patient''s liver abscess ruptured into the liver capsule during treatment, and the lump shrank. Cp-infected liver abscess complicated with hemolytic anemia progresses rapidly, and has a high mortality at early stage, making early diagnosis especially important. When Cp infection is suspected, pathogenic diagnosis should be rapidly confirmed through Gram-staining or next-generation sequencing of puncture fluid/blood, so as to alter patient''s survival outcome through early adjustment of sensitive antimicrobial agents and clearance of infected lesions.