【摘要】 目的分析肺炎克雷伯菌肝脓肿（KPLA）的临床资料,为早期诊断、合理治疗提供参考。方法回顾性分析2009年3月^-2015年7月于南京医科大学第一附属医院住院的156例血培养或脓液培养阳性的细菌性肝脓肿（BLA）患者的病原学特征,根据培养结果,将BLA患者分为KPLA组（n=81）和非肺炎克雷伯菌肝脓肿（NKPLA）组（n=61）,另有14例患者肺炎克雷伯菌培养阳性的同时还获得了大肠埃希菌等其他阳性菌株。比较KPLA和NKPLA的临床、实验室及影像学资料。符合正态分布的计量资料组间比较采用t检验,偏态分布组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ²检验或Fisher精确检验。结果 BLA最常见的致病菌为肺炎克雷伯菌。与NKPLA相比,KPLA更好发于男性（χ²=4.50,P=0.03）,多有糖尿病的基础（χ²=27.28,P<0.001）,患者诉腹痛的比例较低（χ²=5.24,P=0.02）,而NKPLA组患者较KPLA组在基础疾病方面多有胆道疾病、腹部手术史及腹腔内肿瘤史,差异有统计学意义（χ²值分别为18.38、20.87、21.68,P值均<0.001）。实验室检查方面,与KPLA组相比,NKPLA组患者的血红蛋白降低更为明显,差异有统计学意义（t=4.903,P<0.001）。2组患者在影像学检查上均以右侧、单发多见,但KPLA患者出现分隔形成的比例较高,差异有统计学意义（χ²=4.16,P=0.04）。2组患者均出现了肺部感染、胸腔积液、肾周感染等并发症。2组患者均以抗生素联合穿刺治疗为主,其中KPLA组的治疗有效率（93.83%）高于NKPLA组（80.33%）,差异有统计学意义（χ²=6.02,P=0.01）。结论 BLA的主要致病菌为革兰阴性杆菌,尤其是肺炎克雷伯菌。KPLA好发于男性,患者多有糖尿病基础,临床表现常不明显,易出现胸腔积液、肺部感染等并发症,应尽早行影像学检查,及时给予相应治疗。更多还原

【Abstract】 Objective To analyze the clinical data of Klebsiella pneumoniae liver abscess( KPLA),and to provide a reference for early diagnosis and proper treatment. Methods The etiological features of 156 patients with bacterial liver abscess( BLA) and positive culture results who were hospitalized in The First Hospital Affiliated to Nanjing Medical University from March 2009 to July 2015 were analyzed retrospectively. According to the culture results,BLA patients were divided into KPLA group( 81 patients) and non- KPLA( NKPLA) group( 61 patients),and other positive strains including Escherichia coli were found in the other 14 patients with positive culture results for Klebsiella pneumoniae. The clinical,laboratory,and imaging data of KPLA and NKPLA were compared. The t- test was applied for comparison of normally distributed continuous data between groups,and the Mann- Whitney U test was applied for continuous data with skewed distribution between groups; the chi- square test or Fisher’s exact test was applied for comparison of categorical data between groups. Results The most common pathogenic bacteria for BLA were Klebsiella pneumonia. In comparison with the NKPLA group,the KPLA group had a significantly higher proportion of male patients( χ~2= 4. 50,P = 0. 03),a significantly higher proportion of patients with diabetes( χ~2= 27. 28,P < 0. 001),and a significantly lower proportion of patients who complained of abdominal pain( χ~2= 5. 24,P = 0. 02). In the aspects of underlying diseases,the prevalence of biliary tract diseases,previous abdominal surgery,and a history of intraperitoneal tumors showed significant differences between the NKPLA group and the KPLA group( χ~2= 18. 38,20. 87,and 21. 68,all P < 0. 001). As for laboratory examination,the NKPLA group had a significantly greater reduction in hemoglobin compared with the KPLA group( t = 4. 903,P < 0. 001). In terms of imaging examination,most BLA patients showed a single lesion in the right lobe of the liver,but the KPLA group had a significantly higher proportion of patients with the formation of separation( χ~2= 4. 16,P = 0. 04). The patients in both groups experienced complications including pulmonary infection,pleural effusion,and perinephric infection. Most patients were treated with antibiotics combined with puncture,and the KPLA group had a significantly higher response rate than the NKPLA group( 93. 83% vs 80. 33%,χ~2= 6. 02,P = 0. 01).Conclusion The most common pathogenic bacteria for BLA are Gram- negative bacilli,especially Klebsiella pneumoniae. KPLA occurs more commonly in males,and most of the patients have diabetes. The clinical manifestations are not obvious,and the patients tend to develop the complications such as pleural effusion and pulmonary infection. Imaging examination should be performed as early as possible and proper treatment should be given in time.更多还原