糖尿病患者不同HbA<sub>1</sub>c控制水平的肺炎克雷伯杆菌肝脓肿的临床和超声特征-东南大学学报医学版

糖尿病患者不同HbA₁c控制水平的肺炎克雷伯杆菌肝脓肿的临床和超声特征

单位：1. 无锡市第三人民医院超声科, 江苏无锡 214041;
2. 南京医科大学附属无锡人民医院超声医学科, 江苏无锡 214023

分类号：R575.4

出版年·卷·期（页码）：2016·35·第六期（973-978）

摘要：

目的：比较糖尿病（diabetes mellitus，DM）患者不同血糖控制水平下肺炎克雷伯杆菌肝脓肿（Klebsiella pneumoniae liver abscesses，KPLA）的临床和超声特征。方法：146例糖尿病肺炎克雷伯杆菌肝脓肿（diabetes mellitus of Klebsiella pneumoniae liver abscesses，KPLA-DM）患者根据糖化血红蛋白（HbA₁c）浓度分为3组（控制好，HbA₁c≤7%；控制良好，7% < HbA₁c≤9%；控制差，HbA₁c>9%）。分别比较3组的一般情况、临床特点、超声特征及并发症情况。结果：与血糖控制好和良好的患者相比，血糖控制差的患者发病年龄低、住院时间更长（均P<0.05）；更易合并高脂血症、慢性肾功能不全等基础疾病；并发症及需积极抢救的临床危象多见，转移性感染多发（均P<0.05）。KPLA-DM可呈特征性的“片状、团块状增强回声”超声图像，血糖控制差的病人胆道系统积气、肝静脉血栓形成发生率较其他两组明显增高（均P<0.001）。结论：KPLA-DM超声图像具有特征性的“脓腔积气征”。超声观察到的胆道系统积气及肝静脉血栓形成与KPLA-DM患者血糖控制差相关，提示可能存在转移性感染等并发症。

Objective: To analyze the clinic and imaging features of Klebsiella pneumoniae liver abscess(KPLA) in diabetes mellitus(DM) patients with different levels of HbA₁c. Methods: One hundred and forty-six diabetes patients with KPLA were divided into three groups on the basis of their levels of HbA₁c: complete glycemic controlled group(HbA₁c≤7%), good glycemic controlled group(7% < HbA₁c≤9%), bad glycemic controlled group(HbA₁c>9%). Compared the patients' characteristics, clinic features, imaging features and complications among each group. Results: Compared with patients in groups of complete and good glycemic controlled, patients in bad glycemic controlled group tended to have younger age at onset, longer hospital stay and more experience complications such as hyperlipoidemia, chronic renal failure, life-threatening clinical crisis, and higher infection rate(both P<0.05). KPLA-DM could be characterized by "patchy, mass like enhancement echo" ultrasound image. Patients in bad glycemic controlled group also had high risk of biliary pneumatosis, hepatic venous thrombosis and gas-forming pyogenic liver abscess(both P<0.05). Conclusion: The ultrasound image of KPLA has characterized as "abscess cavity gas sign". The complications of hepatic venous thrombosis, gas-forming and infection in diabetes patients with KPLA-DM observed by ultrasound are associated with glycemic uncontrolled, which suggests that there may be other complications such as metastatic infection.

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