CAJ | 학술논문

目的：探讨2型糖尿病与非糖尿病患者合并细菌性肝脓肿的临床特点及差异，为其诊断、治疗提供依据。方法回顾性分析2006年1月至2014年12月济南军区总医院住院治疗细菌性肝脓肿患者113例，其中2型糖尿病并肝脓肿34例，非糖尿病并肝脓肿79例，回顾性分析患者的一般资料、临床表现、实验室检查、影像学表现、合并症、并发症、治疗方法及预后等。结果糖尿病组年龄高于非糖尿病组（P＜0．05），两组男性均多于女性；糖尿病组腹痛、肝区压痛发生率低于非糖尿病组（P＜0．05）；糖尿病组中性粒细胞比值高于非糖尿病组（P＜0．05），血糖水平高于非糖尿病组（P＜0．05），血清白蛋白、血小板计数、二氧化碳结合力及血钠水平低于非糖尿病组（P＜0．05）；两组患者肝脓肿病灶均好发于肝右叶，单发多见，两组间比较差异无统计学意义；最常见的合并疾病为胆道疾病（包括各类胆囊、胆管结石及炎症等），两组间比较差异无统计学意义；主要致病菌为肺炎克雷伯菌，两组间脓液培养结果比较差异有统计学意义（ P＜0．05）；两组治疗及预后差异无统计学意义。结论老年糖尿病患者易并发肝脓肿，其临床症状及体征不明显，易导致漏诊及误诊，主要致病菌为肺炎克雷伯菌，有效的降糖治疗、足量抗革兰阴性杆菌抗生素控制感染、及时脓液穿刺引流是有效治疗方法。
목적：탐토2형당뇨병여비당뇨병환자합병세균성간농종적림상특점급차이，위기진단、치료제공의거。방법회고성분석2006년1월지2014년12월제남군구총의원주원치료세균성간농종환자113례，기중2형당뇨병병간농종34례，비당뇨병병간농종79례，회고성분석환자적일반자료、림상표현、실험실검사、영상학표현、합병증、병발증、치료방법급예후등。결과당뇨병조년령고우비당뇨병조（P＜0．05），량조남성균다우녀성；당뇨병조복통、간구압통발생솔저우비당뇨병조（P＜0．05）；당뇨병조중성립세포비치고우비당뇨병조（P＜0．05），혈당수평고우비당뇨병조（P＜0．05），혈청백단백、혈소판계수、이양화탄결합력급혈납수평저우비당뇨병조（P＜0．05）；량조환자간농종병조균호발우간우협，단발다견，량조간비교차이무통계학의의；최상견적합병질병위담도질병（포괄각류담낭、담관결석급염증등），량조간비교차이무통계학의의；주요치병균위폐염극뢰백균，량조간농액배양결과비교차이유통계학의의（ P＜0．05）；량조치료급예후차이무통계학의의。결론노년당뇨병환자역병발간농종，기림상증상급체정불명현，역도치루진급오진，주요치병균위폐염극뢰백균，유효적강당치료、족량항혁란음성간균항생소공제감염、급시농액천자인류시유효치료방법。
Objective To explore the difference of clinical features of liver abscess between patients with and without type 2 diabetic mellitus ( T2DM ) and provide evidence for diagnosis and treatment . Methods One hundred and thirteen patients with bacterial liver abscess were selected during January 2006 to December 2014 in General Hospital of Jinan Command ,of those,34 were diabetic mellitus patients(DM), and 79 were non-diabetic mellitus patients ( NDM ) .General information , clinical manifestation , laboratory tests,imaging finding,complication,therapeutic method and prognosis of the two groups were analyzed and compared retrospectively .Results The mean age in DM group was higher than that in NDM group ( P<0.05),the most patients were male in the two groups .The incidence rates of abdominal pain ,hepatic region tenderness in DM group was lower than those in NDM group ( P<0.05 ) .Compared with NDM group , the neutrophil percentage(P<0.05)and blood glucose(P<0.05)were higher,but the albumin,blood platelet count,CO2-CP and natrium level were lower in DM group (P<0.05).In the two groups,most of the liver abscesses were found in the right hepatic lobe and solitary liver abscess ,the most complicated diseases were biliary tract tract diseases ( including a variety of calculus and inflammation of gallbladder and bile duct ) ,the differences between the two groups were not significant (P>0.05).Klebsiella pneumonia(KP)was the most common pathogen , and the DM group had a higher prevalence in pus cultures( P<0.05 ) .No significant differences were noted between the two group in terms of therapy and prognosis ( P >0.05 ) . Conclusions Elderly diabetic mellitus patients are susceptible to liver abscess .There are no obvious symptoms and signs in diabetes complicated by liver abscess , which easily result in missed diagnosis and diagnostic errors .Klebsiella pneumonia is the common pathogenic bacteria .Effective control of serum glucose,adequate use of antibiotics and timely liver puncture treatment are effective treatments .