不同毒力肺炎克雷伯菌感染临床表现及CT征象对比分析

目的 对比分析高毒力肺炎克雷伯菌（hvKP）与普通毒力肺炎克雷伯菌（cKP）感染病人的临床资料及CT征象,以提高对hvKP感染的认识和影像诊断能力。方法 回顾性分析经病原学确诊的32例肺炎克雷伯菌感染病人的临床资料及CT表现,依据细菌毒力（拉丝试验）分为2组。其中hvKP组16例,男12例,女4例,平均（57.2±8.3）岁;cKP组16例,男9例,女7例,平均（69.4±7.9）岁。采用独立样本t检验比较实验室检查结果,采用Fisher确切概率检验比较临床症状和CT征象。结果 hvKP组发生寒战、肝区疼痛、恶心症状及合并糖尿病比率高于cKP组,咳嗽咳痰症状比率低于cKP组（均P<0.05）。hvKP组白细胞计数、C-反应蛋白、降钙素原、空腹血糖、碱性磷酸酶均高于cKP组（均P<0.05）。与cKP组相比,hvKP组CT征象中更常见无空洞结节、空洞结节、实变影及合并肝内病灶（均P<0.05）。结论 与cKP感染病人相比,hvKP感染病人的实验室检查、临床及CT表现均具有一定的特征性。

Comparative analysis of CT features and clinical findings of infection caused by different virulent Klebsiella pneumoniae strains

Objective To compare the clinical and CT features of the infection caused by hypervirulent Klebsiella pneumoniae (hvKP) and classic Klebsiella Pneumoniae (cKP), thus improving the recognition and imaging diagnosis of hvKP infection. Methods Thirty-two pneumonia patients caused by Klebsiella pneumoniae, which were confirmed by laboratory examinations, were divided into two groups according to the virulence, including 16 patients in hvKP group (12 males and 4 females, mean age 57.2±8.3 years) and 16 patients in cKP group (9 males and 7 females, mean age 69.4±7.9 years). The independent sample t test was used to compare the laboratory examinations, and the Fisher exact probability test was used to compare the clinical data and CT findings. Results Chill, quadrant abdominal pain, nausea, and diabetes were more common in the hvKP group, while cough and expectoration were less common than in the cKP group (all P<0.05). The white blood cell count, C-reactive protein, procalcitonin, fasting glucose, and alkaline phosphatase were higher in the hvKP group than in the cKP group (all P<0.05). Compared the CT findings of the cKP group, nodules with/without cavity, consolidation shadows in lung and concomitant intrahepatic lesions were more common in the hvKP group (all P<0.05). Conclusion Compared to the cKP group, the laboratory examinations, clinical and imaging features caused by hvKP have certain characteristics.