摘要
目的比较细菌性肝脓肿合并糖尿病与未合并糖尿病患者的临床特征及预后,为临床诊断和治疗提供参考。方法纳入2016年1月至2021年8月于上海交通大学医学院附属同仁医院住院的细菌性肝脓肿患者,收集其临床资料,根据是否合并糖尿病,分成糖尿病组和非糖尿病组进行比较。统计学分析采用χ^(2)检验或Fisher确切概率法,以及多因素logistic回归分析。结果共纳入131例细菌性肝脓肿患者,其中糖尿病组47例,非糖尿病组84例。糖尿病组血小板计数<100×10^(9)/L、C反应蛋白>10 mg/L和总胆红素>17.5μmol/L的比例均小于非糖尿病组,差异均有统计学意义(χ^(2)=3.90、6.44、5.56,均P<0.05)。糖尿病组发生多发性脓肿的比例为10.6%(5/47),小于非糖尿病组的29.8%(25/84),差异有统计学意义(χ^(2)=6.24,P=0.012)。糖尿病组脓液培养肺炎克雷伯菌阳性率为64.9%(24/37),高于非糖尿病组的41.5%(27/65),差异有统计学意义(χ^(2)=5.13,P=0.023)。糖尿病组胸腔积液和其他部位脓肿的发生率分别为29.8%(14/47)和10.6%(5/47),分别高于非糖尿病组的14.3%(12/84)和1.2%(1/84),差异均有统计学意义(χ^(2)=4.55,Fisher确切概率法;均P<0.05)。糖尿病组住院时间>21 d的比例为34.0%(16/47),高于非糖尿病组16.7%(14/84),差异有统计学意义(χ^(2)=5.15,P=0.023)。糖尿病[比值比(OR)=2.654,95%可信区间(CI)1.020~6.907,P=0.046]和脓肿最大径>10 cm(OR=11.045,95%CI 4.493~27.154,P<0.001)是住院时间>21 d的重要危险因素。结论细菌性肝脓肿合并糖尿病患者以单发脓肿更多见,肺炎克雷伯菌感染率更高,更易发生胸腔积液和其他部位脓肿。肝脓肿最大径>10 cm和合并糖尿病会延长住院时间。
Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without diabetes mellitus(DM),to provide a reference for clinical diagnosis and treatment.Methods Patients with bacterial liver abscesses hospitalized in Tongren Hospital,Shanghai Jiao Tong University School of Medicine from January 2016 to August 2021 were enrolled,and their clinical data were collected.The patients were divided into diabetic and non-diabetic groups for comparison according to whether they had comorbid DM.Statistical analysis was performed by chi-square test or Fisher′s exact test,and multivariate logistic regression analysis.Results A total of 131 patients with bacterial liver abscesses were included,including 47 cases in the diabetic group and 84 cases in the non-diabetic group.The percentages of platelet count<100×10^(9)/L,C-reactive protein>10 mg/L,and total bilirubin>17.5μmol/L were lower in the diabetic group than that in the non-diabetic group,and the differences were all statistically significant(χ^(2)=3.90,6.44 and 5.56,respectively,all P<0.05).The percentage of multiple abscesses in the diabetic group was 10.6%(5/47),which was lower than 29.8%(25/84)in the non-diabetic group,and the difference was statistically significant(χ^(2)=6.24,P=0.012).The positive rate of pus culture for Klebsiella pneumoniae was 64.9%(24/37)in the diabetic group,which was higher than 41.5%(27/65)in the non-diabetic group,with a statistically significant difference(χ^(2)=5.13,P=0.023).The incidences of pleural effusion and abscesses at other sites in the diabetic group were 29.8%(14/47)and 10.6%(5/47),respectively,which were both higher than 14.3%(12/84)and 1.2%(1/84)in the non-diabetic group,respectively,and the differences were statistically significant(χ^(2)=4.55,Fisher′s exact test,both P<0.05).The proportion of hospital stays>21 d was 34.0%(16/47)in the diabetic group,which was higher than 16.7%(14/84)in the non-diabetic group,with a statistically significant difference(χ^(2)=5.15,P=0.0
作者
伍月兰
黎家琦
姚宇航
刘岩红
胡建军
张琴
沈婷婷
Wu Yuelan;Li Jiaqi;Yao Yuhang;Liu Yanhong;Hu Jianjun;Zhang Qin;Shen Tingting(Graduate School,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Clinical Medicine,Jilin Medical University,Jilin 132013,China;Department of Infectious Diseases,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China;Phase I Clinical Trial Unit,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)
出处
《中华传染病杂志》
CAS
CSCD
2023年第5期331-337,共7页
Chinese Journal of Infectious Diseases
关键词
细菌性肝脓肿
糖尿病
临床特征
预后
Bacterial liver abscess
Diabetes mellitus
Clinical characteristics
Prognosis
