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目的总结分析隐源性肝脓肿(pyogenic liver abscess,PLA)和胆源性PLA的临床特征差异,为临床诊治隐源性PLA提供依据。方法回顾性分析我院2001-07～2010-06收治的61例PLA临床资料,根据病因分为隐源性组36例,胆源性组25例,对比分析两组的临床资料。结果隐源性PLA多合并糖尿病,胆源性PLA多合并胆道结石,差异有统计学意义(P<0.05);畏寒/发热、白细胞计数升高、CRP升高和单个脓肿在隐源性组高于胆源性组,腹痛、黄疸、AKP升高和多个脓肿在胆源性组高于隐源性组,差异均有统计学意义(P<0.05)。隐源性组血培养阳性率高于胆源性组,隐源性组克雷伯氏菌培养阳性率高于胆源性组,胆源性组大肠埃希氏菌培养阳性率高于隐源性组,两组间比较差异均有统计学意义(P<0.05)。结论与胆源性PLA相比,隐源性PLA伴发糖尿病比例高,大多出现畏寒/发热,白细胞计数和CRP升高明显,多为单发,血培养阳性率较高,主要致病菌为克雷伯氏菌。
Objective To summarize the clinical characteristics of cryptogenic liver abscess (PLA) and biliary PLA, and to provide evidence for the clinical diagnosis and treatment of cryptogenic PLA. Methods The clinical data of 61 PLA patients admitted from 2001-07 to 2010-06 in our hospital were retrospectively analyzed. According to the cause, 36 cases of cryptogenic group and 25 cases of biliary group were divided into two groups. The clinical data of two groups were compared. Results There was a significant difference in cryptogenic PLA combined with diabetes mellitus and gallbladder PLA complicated with biliary calculi (P <0.05). Chills / fever, elevated white blood cell count, elevated CRP and single abscess in cryptogenic group Higher than the biliary group, abdominal pain, jaundice, AKP increased and multiple abscesses in the biliary group higher than the cryptogenic group, the difference was statistically significant (P <0.05). The positive rate of blood culture in the cryptogenic group was higher than that of the biliary group, the positive rate of the Klebsiella pneumoniae culture group was higher than that of the biliary group, and the positive rate of the bile-derived group of Escherichia coli culture was higher than that of the cryptogenic group The difference between the two groups was statistically significant (P <0.05). Conclusions Compared with biliary PLA, cryptogenic PLA has a high proportion of patients with diabetes mellitus, most of them have chills / fever, and the white blood cell count and CRP increase obviously. Most of them are solitary and the positive rate of blood culture is high. The main pathogenic bacteria Klebsiella.