Diagnosis and Treatment for Diabetes Mellitus with Pyogenic Liver Abscess_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

林斌 ,  刘坤

Corresponding author：

刘坤, Email: hengjialiu@sina.com

Keywords：

细菌性肝脓肿; 糖尿病; 抗生素; 引流

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目的总结糖尿病并细菌性肝脓肿(DPHA)的临床特点和诊治经验。方法回顾性分析我院2002年3月至2010年12月期间出院的DPHA与无DPHA(NDPHA)患者的临床资料。结果细菌性肝脓肿患者共22例，其中DPHA患者11例。DPHA组人口学特征、临床表现、白细胞计数与NDPHA组比较差异均无统计学意义(P gt;0.05); DPHA组血白蛋白低于NDPHA(P=0.006)，而ALT高于NDPHA(P=0.006)。DPHA组病灶个数多于NDPHA组(P=0.032)，且病灶直径也大于NDPHA组(P=0.006)。脓培养: 2组大肠杆菌均为3例; DPHA组克雷伯杆菌4例，而NDPHA组无克雷伯杆菌。DPHA组发生切口感染7例、腹腔感染2例，NDPHA组发生切口感染3例。 DPHA组抗生素使用时间、住院时间及住院费用均高于NDPHA组(P lt;0.05)。2组均分别治愈6例、好转5例，2组均无死亡患者。结论DPHA有其特殊的临床特征，并发症多，住院费用高，但预后与NDPHA差别不大。

Citation： 林斌,刘坤. Diagnosis and Treatment for Diabetes Mellitus with Pyogenic Liver Abscess. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1319-1320. doi: Copy

1.	Thomsen RW, Jepsen P, Srensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis [J]. Clin Infect Dis, 2007, 44(9): 11941201.
2.	王永笛, 宋振河, 刘奉, 等. 19例糖尿病合并细菌性肝脓肿临床诊疗分析 [J]. 中国医药导报, 2007, 4(35): 3840.
3.	吕文才, 付维利, 孙红梅. 合并有糖尿病的细菌性肝脓肿诊治经验 [J]. 肝胆胰外科杂志, 2005, 17(3): 230231.
4.	Foo NP, Chen KT, Lin HJ, et al. Characteristics of pyogenic liver abscess patients with and without diabetes mellitus [J]. Am J Gastroenterol, 2010, 105(2): 328335.
5.	钱荣立. 关于糖尿病的新诊断标准与分型 [J]. 中国糖尿病杂志, 2000, 8(1): 56.
6.	Yang CC, Chen CY, Lin XZ, et al. Pyogenic liver abscess in Taiwan: Emphasis on gasforming liver abscess in diabetics [J]. Am J Gastroenterol, 1993, 88(11): 19111915.
7.	程桂莲，王少峰，骆成林，等. 40例细菌性肝脓肿的临床分析及治疗体会 [J]. 胃肠病学和肝病学杂志, 2009， 18(12): 11331135.
8.	吴旻, 周华, 俞云松, 等. 细菌性肝脓肿合并糖尿病与非合并糖尿病者临床及病原菌分析 [J]. 浙江医学, 2008, 30(9): 10011003.
9.	Cerwenka H. Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and central Europe [J]. World J Gastroenterol, 2010, 16(20): 24582462.
10.	Chen SC, Tsai SJ, Chen CH, et al. Predictors of mortality in patients with pyogenic liver abscess [J]. Neth J Med, 2008, 66(5): 196203.
11.	Yang YS, Siu LK, Yeh KM, et al. Recurrent klebsiella pneumoniae liver abscess: clinical and microbiological characteristics [J]. J Clin Microbiol, 2009, 47(10): 33363339.
12.	Kang C, Kim SH, Bang JW, et al. Communityacquired versus nosocomial klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance [J]. J Korean Med Sci, 2006, 21(5): 816822.
13.	Chen SC, Wu WY, Yeh CH, et al. Comparison of Escherichia coli and klebsiella pneumoniae liver abscesses [J]. Am J Med Sci, 2007, 334(2): 97105.
14.	甄作均, 陈焕伟, 崔伟珍. 细菌性肝脓肿62例诊治经验分析 [J]. 中国实用外科杂志, 2007, 27(12): 993994.
15.	刘强, 王亚军, 刘家峰, 等. 细菌性肝脓肿治疗的单中心20年回顾分析 [J]. 中国普外基础与临床杂志, 2009, 16(5): 389392.
16.	刘强, 曹锋, 王亚军, 等. 细菌性肝脓肿经皮穿刺置管引流与细针抽吸疗效比较 [J]. 中国普外基础与临床杂志, 2010, 17(10): 10831086.
17.	陈青, 郑冬梅, 管庆波, 等. 2型糖尿病并细菌性肝脓肿48例临床分析 [J]. 内科急危重症杂志, 2008, 14(4): 211212.
18.	罗庆锋, 许乐. 糖尿病并发细菌性肝脓肿临床特点及诊治探讨 [J]. 国外医学·消化系疾病分册, 2005, 25(5): 328331.
19.	Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan [J]. Emerg Infect Dis, 2008, 14(10): 15921600.
20.	Chan KS, Yu WL, Tsai CL, et al. Pyogenic liver abscess caused by klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients [J]. Chin Med J (Engl), 2007, 120(2): 136139.
21.	刘漪, 蓝红林, 袁晟光. 糖尿病合并细菌性肝脓肿临床分析 [J]. 华夏医学, 2007, 20(2): 238239.
22.	赵欣, 王邦茂, 张继红, 等. 糖尿病并发细菌性肝脓肿的临床特点及诊治探讨 [J]. 胃肠病学和肝病学杂志, 2007, 16(4): 384387.

1. Thomsen RW, Jepsen P, Srensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis [J]. Clin Infect Dis, 2007, 44(9): 11941201.
2. 王永笛, 宋振河, 刘奉, 等. 19例糖尿病合并细菌性肝脓肿临床诊疗分析 [J]. 中国医药导报, 2007, 4(35): 3840.
3. 吕文才, 付维利, 孙红梅. 合并有糖尿病的细菌性肝脓肿诊治经验 [J]. 肝胆胰外科杂志, 2005, 17(3): 230231.
4. Foo NP, Chen KT, Lin HJ, et al. Characteristics of pyogenic liver abscess patients with and without diabetes mellitus [J]. Am J Gastroenterol, 2010, 105(2): 328335.
5. 钱荣立. 关于糖尿病的新诊断标准与分型 [J]. 中国糖尿病杂志, 2000, 8(1): 56.
6. Yang CC, Chen CY, Lin XZ, et al. Pyogenic liver abscess in Taiwan: Emphasis on gasforming liver abscess in diabetics [J]. Am J Gastroenterol, 1993, 88(11): 19111915.
7. 程桂莲，王少峰，骆成林，等. 40例细菌性肝脓肿的临床分析及治疗体会 [J]. 胃肠病学和肝病学杂志, 2009， 18(12): 11331135.
8. 吴旻, 周华, 俞云松, 等. 细菌性肝脓肿合并糖尿病与非合并糖尿病者临床及病原菌分析 [J]. 浙江医学, 2008, 30(9): 10011003.
9. Cerwenka H. Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and central Europe [J]. World J Gastroenterol, 2010, 16(20): 24582462.
10. Chen SC, Tsai SJ, Chen CH, et al. Predictors of mortality in patients with pyogenic liver abscess [J]. Neth J Med, 2008, 66(5): 196203.
11. Yang YS, Siu LK, Yeh KM, et al. Recurrent klebsiella pneumoniae liver abscess: clinical and microbiological characteristics [J]. J Clin Microbiol, 2009, 47(10): 33363339.
12. Kang C, Kim SH, Bang JW, et al. Communityacquired versus nosocomial klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance [J]. J Korean Med Sci, 2006, 21(5): 816822.
13. Chen SC, Wu WY, Yeh CH, et al. Comparison of Escherichia coli and klebsiella pneumoniae liver abscesses [J]. Am J Med Sci, 2007, 334(2): 97105.
14. 甄作均, 陈焕伟, 崔伟珍. 细菌性肝脓肿62例诊治经验分析 [J]. 中国实用外科杂志, 2007, 27(12): 993994.
15. 刘强, 王亚军, 刘家峰, 等. 细菌性肝脓肿治疗的单中心20年回顾分析 [J]. 中国普外基础与临床杂志, 2009, 16(5): 389392.
16. 刘强, 曹锋, 王亚军, 等. 细菌性肝脓肿经皮穿刺置管引流与细针抽吸疗效比较 [J]. 中国普外基础与临床杂志, 2010, 17(10): 10831086.
17. 陈青, 郑冬梅, 管庆波, 等. 2型糖尿病并细菌性肝脓肿48例临床分析 [J]. 内科急危重症杂志, 2008, 14(4): 211212.
18. 罗庆锋, 许乐. 糖尿病并发细菌性肝脓肿临床特点及诊治探讨 [J]. 国外医学·消化系疾病分册, 2005, 25(5): 328331.
19. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan [J]. Emerg Infect Dis, 2008, 14(10): 15921600.
20. Chan KS, Yu WL, Tsai CL, et al. Pyogenic liver abscess caused by klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients [J]. Chin Med J (Engl), 2007, 120(2): 136139.
21. 刘漪, 蓝红林, 袁晟光. 糖尿病合并细菌性肝脓肿临床分析 [J]. 华夏医学, 2007, 20(2): 238239.
22. 赵欣, 王邦茂, 张继红, 等. 糖尿病并发细菌性肝脓肿的临床特点及诊治探讨 [J]. 胃肠病学和肝病学杂志, 2007, 16(4): 384387.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment for Diabetes Mellitus with Pyogenic Liver Abscess

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