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1、疑难病杂志2003年10月第2卷第5期JDifficandComplCas,October182003,Vol.2No.5263·论著·糖尿病合并肝脓肿的临床特点和治疗盛正妍顾鸣宇黄云鸿吴艺捷【摘要】目的探讨糖尿病合并肝脓肿(diabetichepaticabscess,DHA)的临床特点和有效治疗方法。方法对1994年5月～2003年3月我院收治的29例DHA和64例非糖尿病肝脓肿(nondiabetiche-paticabscess,NDHA)进行对比总结。结果29例DHA均为2型糖尿病患者,老年人居多,男女发病相似,64例NDHA以中年人为多,男略多于女;DHA的诱因主要为肺部
2、感染、胆囊炎胆结石、尿路感染、腹腔肿瘤,而NDHA为胆道疾患、腹腔手术等;病原菌DHA主要为肺炎克雷伯杆菌、坚实牙胞杆菌、大肠杆菌,NDHA为粪肠球菌、模仿葡萄球菌、肺炎克雷伯杆菌等;DHA组治愈率较NDHA组低(37.9%和62.5%),P<0.05;平均住院时间较NDHA组长,分别为(32.4±10.2)d和(23.8±11.1)d,P<0.05;DHA组应用抗生素时间较NDHA组长而量大。结论DHA是糖尿病感染中严重的感染症之一,与长期高血糖有关。及早用胰岛素控制血糖至正常、应用足量抗革兰阴性杆菌抗生素控制感染、及时脓液穿刺手术,是DHA的有效治疗方法。【关键词】糖尿病;肝脓肿
3、;感染;临床表现;治疗【中图分类号】R575.4;R587.2【文献标识码】A【文章编号】1671-6450(2003)05-0263-03AstudyontheclinicalcharacteristicsandtreatmentofdiabetesmellituscomplicatedbyhepaticabscessSHENGZhengyan,GUMingyu,HUANGYunhong,etal.DepartmentofEndocrinology,ShanghaiFirstHospital,Shanghai200080,China【Abstract】ObjectiveToinve
4、stigatetheclinicalcharacteristicsandtreatmentofdiabetichepaticabscess(DHA).Methods29casesofDHAand64casesofnondiabetichepaticabscess(NDHA)wereretrospectivelyana-lyzed.Results29casesofDHAwerealltype2diabetesmellitus,andDHAoccurredmorefrequentlyinsenilepa-tients,withsimilarmorbidityinbothsexes.The
5、predisposingfactorsofDHAwerepulmonaryinfection,acutecholecys-titis,urinarytractinfectionandintraabdominaltumor;whileinNDHA,biliarytractdisorderandintraabdominalopera-tionweremaininducingfactors.Klebsiellapneumoniae,BacillusceaeusandEscherichiacoliwerethemajorpathogensinDHA,whileEnterococcusfaec
6、alisstaphylococcussimulans,KlebsiellapneumoniaeandsooninNDHA.ThecurerateinDHAwaslowerthanthatinNDHA(37.9%vs62.5%),P<0.05,andthemeanhospitalizationtimeinDHAwaslongerthanthatinNDHA(32.4±10.2vs23.8±11.1days),P<0.05.ConclusionDHAisoneofthesevereinfectionsinpatientswithdiabetesmellitus,andpromptdrai
7、nage,earlyadministrationofinsulinandade-quateantibioticsareofmostimportancetotheprognosisofDHA.【Keywords】Diabetesmellitus;Hepaticabscess;Infection;Clinicalmanifestation;Therapy糖尿病患者极容易并发各种感染,感染又可加1对象及方法[1]重糖尿病,诱发酮症酸中毒,增加糖尿病病死率。1.1
