摘要
目的对比病原学阴性肝脓肿(CNLA)与病原学阳性肝脓肿(CPLA)的临床特点及预后,为早期诊断及有效治疗提供参考。方法回顾性分析2005年—2018年空军军医大学第二附属医院收治的371例肝脓肿病例,其中病原学检查阳性(CPLA组)145例(39.1%),病原学阴性(CNLA组)226例(60.9%)。比较CNLA组与CPLA组的临床特点、实验室检查、影像学资料及预后。满足正态分布或近似正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2或Fisher精确检验。结果与CNLA组比较,CPLA组患者年龄较大(t=-3.464,P=0.001),多合并糖尿病(χ^2=17.362,P<0.001)、心血管疾病(χ^2=10.827,P=0.001);CNLA组多合并AIDS(χ^2=4.354,P=0.037)。与CNLA组比较,CPLA组白细胞计数及中性粒细胞百分比、ALP、GGT、TBil升高更明显(U值分别为20393、19711、18586、19349、18496,P值均<0.05),白蛋白降低更显著(t=3.348,P=0.001),基线APACHEⅡ评分≥16分占比更高(χ^2=9.550,P=0.002)。CPLA组脓肿直径多大于5 cm,与CPLA组比较差异有统计学意义(χ^2=53.61,P<0.001)。CNLA组选用单纯抗感染治疗相对较多(19.9%),但两组仍以抗感染联合B超或CT引导下脓肿穿刺引流为主要治疗方法。两组患者在住院天数、复发率及病死率方面差异均无统计学意义(P值均>0.05)。结论CNLA组患者年龄较小,不易出现较重的炎症反应和肝功能不全,脓肿直径小不易穿刺引流多见,但整体预后与CPLA无明显差异。常规覆盖肺炎克雷伯菌的经验性抗感染治疗对CNLA患者有效。
Objective To investigate the clinical features and prognosis of culture-negative liver abscess(CNLA)versus culture-positive liver abscess(CPLA),and to provide a reference for early diagnosis and effective treatment.Methods A retrospective analysis was performed for the clinical data of 371 patients with liver abscess who were admitted to The Second Affiliated Hospital of Air Force Medical University from 2005 to 2018,among whom 145(39.1%)had positive results of pathogen test(CPLA group)and 226(60.9%)had negative results(CNLA group).The two groups were compared in terms of clinical features,laboratory examination,imaging data,and prognosis.The t-test was used for comparison of normally distributed or approximately normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Results Compared with the CNLA group,the CPLA group had a significantly older age(t=-3.464,P=0.001)and a significantly higher proportion of patients with diabetes(χ^2=17.362,P<0.001)or cardiovascular disease(χ^2=10.827,P=0.001),and compared with the CPLA group,the CNLA group had a significantly higher proportion of patients with AIDS(χ^2=4.354,P=0.037).Compared with the CNLA group,the CPLA group had significantly greater increases in leukocyte count,percentage of neutrophils,alkaline phosphatase,gamma-glutamyl transpeptidase,and total bilirubin(U=20393,19711,18586,19349,and 18496,all P<0.05),a significantly greater reduction in albumin(t=3.348,P=0.001),and a significantly higher proportion of patients with a baseline APACHEⅡscore of≥16(χ^2=9.550,P=0.002).Compared with the CNLA group,the CPLA group had a significantly higher proportion of tumors with a diameter of>5 cm(χ^2=53.61,P<0.001).In the CNLA group,19.9%of the patients were treated with anti-infective therapy alone,while for both groups,anti-infective therapy combined with ultrasound-or CT-guided percutaneous drainage was the main treatment method.There were no significant differences in the length of hospital stay,recurrence rate,and mortality rate between the two groups(all P>0.05).Conclusion Compared with CPLA patients,CNLA patients tend to have a younger age and are less likely to develop severe inflammatory response and liver insufficiency,with a smaller diameter of abscess which is less likely to be treated by percutaneous drainage,while there is no significant difference in prognosis between CPLA patients and CNLA patients.
作者
郝建宏
姚娜
毕铭辕
张谷芬
王临旭
连建奇
汪春付
HAO Jianhong;YAO Na;BI Minyuan;ZHANG Gufen;WANG Linxu;LIAN Jianqi;WANG Chunfu(Department of General Practice,The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia 014010,China;Department of Infectious Diseases,The Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第1期110-114,共5页
Journal of Clinical Hepatology
基金
十三五国家科技重大专项(2017ZX10204401-002-005)。
关键词
肝脓肿
细菌感染
体征和症状
Liver Abscess
Bacterial Infections
Signs and Symptoms
