2型糖尿病合并细菌性肝脓肿39例临床分析

目的总结2型糖尿病合并细菌性肝脓肿的临床特点和诊治经验,提高诊疗水平。方法回顾性分析攀枝花市中心医院2000年7月至2009年7月收治的39例2型糖尿病合并细菌性肝脓肿病例的临床资料。结果 2型糖尿病合并细菌性肝脓肿以中老年患者多见,男性多于女性,且多见于血糖控制不佳的患者。感染途径以胆道系统为主,其次为隐源性感染。临床上多有发热等症状,但局部定位体征不明显。血液及脓液培养阳性率低,致病菌以肺炎克雷伯杆菌为主。肝脏B超、CT等检查仍是确诊肝脓肿的主要手段。治疗后38例体温正常、脓腔缩小后好转出院,1例因感染性休克死亡。结论早期诊断,有效控制血糖,合理应用抗生素,加强营养支持和脓腔的个体化治疗是糖尿病合并细菌性肝脓肿治疗的关键。

Type 2 Diabetes Mellitus with Bacterial liver Abscess: Clinical Analysis of 39 Cases

Objectives To summarize the clinical features, diagnosis and treatment of type 2 diabetes mellitus with bacterial liver abscess, in order to elevate the level of diagnosis and treatment. Methods The clinical data of 39 cases of diabetes mellitus with bacterial liver abscess in Panzhihua center hospital from 2000 to 2009 were analyzed in this retrospective study. Results Type 2 Diabetes mellitus with bacterial liver abscess often occurred in middle-age and old- age patients, and in more male than female. Most of them had not adequately controlled their serum glucose. The main route of infection was biliary system, cryptogenic infection was next. The main symptoms include fever, but the local physical sign was atypia. Blood culture and liquor puris culture had lower positive rate. The Klebsiella pneumoniae was the main pathogenic bacterium. Liver B-ultrasonography and CT was the first selected method in the diagnosis. 38 cases recovered after treatment, one case died because of septic shock. Conclusions The key of treatment for diabetes mellitus with bacterial liver abscess include early diagnosis, controlling blood glucose, reasonable application of antibiotics, enhancing nutritional support and individuation treatment about vomica.