CAJ | 학술논문

目的：探讨细菌性肝脓肿在糖尿病患者中的流行病学、病原学、治疗现状及预后相关因素。方法将符合化脓性肝脓肿诊断标准的272例患者分成糖尿病组（131例）和非糖尿病组（141例），并根据治疗手段分成保守治疗及侵入性治疗两个亚组。观察并比较所有患者的一般情况、病原菌感染情况及感染途径。采用Logistic回归分析化脓性肝脓肿对糖尿病患者预后的相关因素。结果与非糖尿病患者比较，糖尿病组患者的发病年龄高（t=2.276，P=0.031），住院时间长（t=2.163，P=0.018）。两组患者均以肺炎克雷伯杆菌感染为主，且糖尿病组患者该菌的培养阳性率明显高于非糖尿病组患者（39/131 vs.18/141，χ2=11.855，P＜0.001）。在感染途径上，糖尿病组以隐源性感染为主（53/131，40.5%），非糖尿病组以经胆道感染为主（38/141，35.5%）。与非糖尿病组患者比较，糖尿病组隐源性感染率及经肝动脉感染率较高（χ2=5.565，P=0.018；χ2=4.430，P=0.035），经门静脉感染率较低（χ2=6.372，P=0.012）。感染性休克、既往恶性肿瘤史为糖尿病组预后的独立危险因素，高胆红素血症（血清总胆红素＞20μmol/L）、感染性休克为非糖尿病组预后的独立危险因素（P均＜0.05），而及时行侵入性治疗为两组患者的共同保护性因素（P均＜0.05）。结论对于化脓性肝脓肿合并糖尿病患者应在积极抗感染治疗的同时及时予以侵入性治疗。
목적：탐토세균성간농종재당뇨병환자중적류행병학、병원학、치료현상급예후상관인소。방법장부합화농성간농종진단표준적272례환자분성당뇨병조（131례）화비당뇨병조（141례），병근거치료수단분성보수치료급침입성치료량개아조。관찰병비교소유환자적일반정황、병원균감염정황급감염도경。채용Logistic회귀분석화농성간농종대당뇨병환자예후적상관인소。결과여비당뇨병환자비교，당뇨병조환자적발병년령고（t=2.276，P=0.031），주원시간장（t=2.163，P=0.018）。량조환자균이폐염극뢰백간균감염위주，차당뇨병조환자해균적배양양성솔명현고우비당뇨병조환자（39/131 vs.18/141，χ2=11.855，P＜0.001）。재감염도경상，당뇨병조이은원성감염위주（53/131，40.5%），비당뇨병조이경담도감염위주（38/141，35.5%）。여비당뇨병조환자비교，당뇨병조은원성감염솔급경간동맥감염솔교고（χ2=5.565，P=0.018；χ2=4.430，P=0.035），경문정맥감염솔교저（χ2=6.372，P=0.012）。감염성휴극、기왕악성종류사위당뇨병조예후적독립위험인소，고담홍소혈증（혈청총담홍소＞20μmol/L）、감염성휴극위비당뇨병조예후적독립위험인소（P균＜0.05），이급시행침입성치료위량조환자적공동보호성인소（P균＜0.05）。결론대우화농성간농종합병당뇨병환자응재적겁항감염치료적동시급시여이침입성치료。
Objective To investigate and analyze the epidemiology, etiology, treatment and prognostic factors of pyogenic liver abscess in patients with diabetes mellitus. Methods A total of 272 patients conformed to having pyogenic liver abscess diagnostic criteria were divided into the diabetes mellitus group (131 cases) and non-diabetes mellitus group (141 cases), and patients were further divided into conservative therapy and invasive therapy according to the different treatment. The general condition, pathogen infection and route of infection were recorded and compared. Logistic regression analysis was used to determine the prognostic factors associated with pyogenic liver abscess in patients with diabetes mellitus. Results Compared with the non-diabetes mellitus group, age was higher (t=2.276, P=0.031) and the length of stay were longer (t= 2.163, P=0.018) in the diabetes mellitus group. Klebsiella pneumoniae infection was the major pathogen in the two groups, and positive rate in the diabetes mellitus group were higher than those in the non-diabetes mellitus group (39 / 131 vs. 18 / 141, χ2= 11.855, P <0.001). Patients in the diabetes mellitus group had priority of hidden source of infection (53/131, 40.5%), and patients in the non-diabetes mellitus group had priority of biliary infection (38/141, 35.5%). Compared with the non-diabetes mellitus group, the rates of hidden source infection and hepatic artery infection increased (χ2=5.565, P=0.018; χ2=4.430, P=0.035), the rate of portal vein infection decreased in the diabetes mellitus group ( χ2= 6.372, P = 0.012). Septic shock and malignancy were independent predictors in the diabetes mellitus group, hyperbilirubinemia (total bilirubin > 20 μmol / L) and septic shock were independent predictors in the non-diabetes mellitus group, and invasive therapy was protective factors in both groups (all P<0.05). Conclusion Patients with pyogenic liver abscess and diabetes mellitus should receive positive anti-infection treatment and invasive therapy early.