[1]侯秋晨,戴明佳,韩方正*.细菌性肝脓肿合并2型糖尿病的临床特征及疗效预测因素分析[J].徐州医科大学学报,2021,41(03):194-199.[doi:10.3969/j.issn.2096-3882.2021.03.008]
 Analysis of the predictive factors for the effectiveness of bacterial liver abscess inpatients with type 2 diabetes mellitus[J].Journal of Xuzhou Medical University,2021,41(03):194-199.[doi:10.3969/j.issn.2096-3882.2021.03.008]
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细菌性肝脓肿合并2型糖尿病的临床特征及疗效预测因素分析()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
41
期数:
2021年03期
页码:
194-199
栏目:
出版日期:
2021-03-25

文章信息/Info

Title:
Analysis of the predictive factors for the effectiveness of bacterial liver abscess inpatients with type 2 diabetes mellitus
作者:
侯秋晨戴明佳韩方正*
徐州医科大学附属医院感染性疾病科,江苏徐州221002
关键词:
细菌性肝脓肿2型糖尿病临床特征疗效预测因素
分类号:
R575.4
DOI:
10.3969/j.issn.2096-3882.2021.03.008
文献标志码:
A
摘要:
目的探讨细菌性肝脓肿(BLA)合并2型糖尿病(T2DM)的临床特征,分析BLA疗效预测因素。方法将2015年1月—2019年12月住院的494例BLA患者分为T2DM组(n=191)和非T2DM组(n=303),比较2组一般资料、实验室及影像学检查、并发症及治疗方式;再根据出院时治疗结果将494例BLA患者分为治疗有效组(治愈或好转)和无效组(治疗无效、加重或死亡),单因素及多因素Logistic回归分析BLA疗效预测因素。结果T2DM组住院时间,C-反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞百分比(NE%)升高患者占比,肺炎克雷伯菌检出率,积气脓肿占比,菌血症、低蛋白血症发生率高于非T2DM组(P均<0.05)。单纯抗生素及抗生素分别联合穿刺抽脓、置管引流、外科手术4种治疗中,仅抗生素联合置管引流在T2DM组与非T2DM组间的差异有统计学意义(P=0.019)。治疗有效组和无效组行Logistic多因素分析显示抗生素联合置管引流可改善BLA疗效(OR=0.027,P=0.011);尿素氮>7.86 mmol/L(OR=7.655,P=0.010)、感染性休克(OR=9.247,P=0.022)、腹腔积液(OR=41.911,P=0.002)、天冬氨酸氨基转移酶(AST)>40 U/L(OR=6.797,P=0.043)会导致BLA疗效不佳。结论BLA合并T2DM时感染更重,住院时间更长,并发症发生率更高。抗生素联合置管引流可改善BLA疗效,尿素氮>7.86 mmol/L、感染性休克、腹腔积液、AST>40 U/L是BLA疗效不佳的预测因素。
Abstract:
ObjectiveTo discuss the clinical features of bacterial liver abscess (BLA) in patients with type 2 diabetes mellitus (T2DM), and analyzed the predictive factors of BLA effectiveness. MethodsA total of 494 BLA patients who were admitted into hospital from January 2015 to December 2019 were enrolled and divided into two groups: a T2DM group (n=191) and a non-T2DM group (n=303). The two groups were compared for general information, laboratory and imaging examination, complications and treatment methods. According to their outcome, the patients were divided into two groups: an effective group (cure or remission) and an ineffective group (failure to responding to treatment, aggravation or death) and their predictive factors for BLA effectiveness was analyzed by univariate and multivariate logistic regression. ResultsFor BLA patients with T2DM, their length of hospitalization stay, the percentages of patients with increases in C-reaction protein (CRP), procalcitonin (PCT) and neutrophil percentage (NE%), the detection rate of Klebsiella pneumoniae, the percentage of gas accumulation abscess, the incidence of bacteremia and hypoproteinemia were significantly higher than those in the non-T2DM group (P<0.05). The patients received one of the four treatment methods: antibiotics alone or a combined use of antibiotics and puncture pumping pus, percutaneous catheter drainage or surgery. Only antibiotics and catheter drainage showed significant differences in effectiveness between the T2DM and non-T2DM groups (P=0.019). Multivariate logistic analysis showed that the combined use of antibiotics and catheter drainage can improve the effectiveness of BLA (OR=0.027, P=0.011). Meanwhile, urea nitrogen>7.86 mmol/L (OR=7.655, P=0.010), septic shock (OR=9.247, P=0.022), abdominal effusion (OR=41.911, P=0.002) and aspartate aminotransferase (AST) > 40 U/L (OR=6.797, P=0.043) resulted in poor effectiveness of BLA. ConclusionsBLA patients with T2DM have more severe infection and longer length of hospitalization stay, with a higher incidence of complications. The combined use of antibiotics and catheter drainage can improve the effectiveness of BLA, while urea nitrogen > 7.86 mmol/L, septic shock, abdominal effusion and AST > 40 U/L are the predictive factors for poor BLA effectiveness.

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更新日期/Last Update: 2021-04-25