不同糖化血红蛋白水平的糖尿病患者合并细菌性肝脓肿的临床特征分析

王维钊; 朱沁玲; 向晓星; 马莉; 居梦娴; 金小龙; 王永超; 韩维维; 徐庆成

doi:10.3969/j.issn.1001-5256.2019.11.029

不同糖化血红蛋白水平的糖尿病患者合并细菌性肝脓肿的临床特征分析

DOI: 10.3969/j.issn.1001-5256.2019.11.029

1. 扬州大学临床医学院消化内科
2. 大连医科大学研究生院
3. 扬州大学临床医学院血液病学研究所

详细信息

中图分类号: R587.2;R575.4
计量
- 文章访问数: 1295
- HTML全文浏览量: 58
- PDF下载量: 279
- 被引次数: 12
出版历程
- 收稿日期: 2019-06-11
- 出版日期: 2019-11-20

Clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin

Department of Gastroenterology,School of Clinical Medicine,Yangzhou University

摘要

摘要:
目的探讨不同糖化血红蛋白（HbAlc）水平的糖尿病患者合并细菌性肝脓肿的临床特征。方法纳入2014年12月-2018年12月入住江苏省苏北人民医院的118例成年糖尿病合并细菌性肝脓肿患者,按照不同HbAlc水平分成3组,即良好组（n=32）、一般组（n=31）、较差组（n=55）,比较分析3组的一般资料、临床表现、检验检查结果、并发症和病原学检查。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ2检验或Fisher确切概率法。结果不同HbAlc水平患者相比较,3组间平均年龄、住院时长组间差异均有统计学意义（F值分别为2. 933、3. 310,P值分别为0. 016、0. 044）,HbAlc水平较差组较控制良好组平均发病年龄低,且住院时长更长（P值均<0. 05）。糖尿病合并肝脓肿基础疾病占比排在第一位的是高血压,其次为胆道疾病,再次为脑梗死,3组患者基础疾病在脑梗死方面差异有统计学意义（χ2=6. 135,P=0. 037）。较差组与其他两组比较腹部压痛体征少,不典型（χ2
- 肝脓肿,化脓性 /
- 糖尿病 /
- 血红蛋白A,糖基化 /
- 体征和症状
Abstract:
Objective To investigate the clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin( Hb Alc). Methods A total of 118 adult diabetic patients with bacterial liver abscess who were admitted to our hospital from December 2014 to December 2018 were enrolled,and according to the level of Hb Alc,they were divided into well-controlled group with 32 patients,fairly-controlled group with 31 patients,and poorly-controlled group with 55 patients. The three groups were compared in terms of general data,clinical manifestations,laboratory results,complications,and pathogen test results. A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results There were significant differences in mean age and length of hospital stay between the three groups( F = 2. 933 and 3. 310,both P < 0. 05). Compared with the other two groups,the poorly-controlled group had a significantly younger mean age of onset( P = 0. 016) and a significantly longer length of hospital stay( P = 0. 044). Hypertension was the most common underlying disease in diabetic patients with liver abscess,followed by biliary tract diseases and cerebral infarction,and there was a significant difference in cerebral infarction between the three groups( χ2= 6. 135,P =0. 037). Compared with the well-controlled group,the poorly-controlled group had significantly fewer and less typical signs of abdominal tenderness( χ2= 6. 178,P = 0. 046),and compared with the other two groups,the poorly-controlled group tended to have a significant increase in C-reactive protein( χ2= 5. 985,P = 0. 049) and were more likely to develop sepsis( χ2= 6. 247,P = 0. 044). Conclusion For diabetic patients with bacterial liver abscess,the patients with a poorly controlled Hb Alc level often have a young age of onset,a long length of hospital stay,and atypical clinical signs and are likely to develop sepsis,which may lead to insufficient attention in clinical practice,delay diagnosis and treatment,and even endanger life,and therefore,such patients should be taken seriously in clinical practice.
- liver abscess,pyogenic /
- diabetes mellitus /
- hemoglobin A,glycosylated /
- signs and symptoms

HTML全文

参考文献(19)

[1] AKHONDI H,SABIH DE. Liver abscess[M]. Treasure Island(FL):Stat Pearls Publishing Stat Pearls Publishing LLC,2019.

[2] LI W,CHEN H,WU S,et al. A comparison of pyogenic liver abscess in patients with or without diabetes:A retrospective study of246 cases[J]. BMC Gastroenterol,2018,18(1):144.

[3] WANG HH. The association of haemoglobin A(1)C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus[J]. Eur Radiol,2014,24(5):980-989.

[4] WHO. New diagnostic criteria and typing system for diabetes[J]. Chin J Diabetes,2000,8(1):5-6.(in Chinese)WHO．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.

[5] CHEN J. Cryptogenic and non-cryptogenic liver abscess:A retrospective analysis of 178 cases revealed distinct characteristics[J]. Int Med Res,2018,46(9):3824-3836.

[6] KUBOVY J,KARIM S,DING S,et al. Pyogenic liver abscess:Incidence,causality,management and clinical outcomes in a New Zealand cohort[J]. N Z Med J,2019,132(1492):30-35.

[7] WANG WJ,TAO Z,WU HL,et al. Etiology and clinical manifestations of bacterial liver abscess:A study of 102 cases[J]. Medicine(Baltimore),2018,97(38):e12326.

[8] MCEWAN P,FOOS V,LAMOTTE M,et al. The impact of baseline Hba1c and Hba1c trajectories on time to therapy escalation in type 2 diabetes mellitus[J]. Value Health,2015,18(7):a698.

[9] WALRAVEN L. Distinct HbA1c trajectories in a type 2 diabetes cohort[J]. Acta Diabetol,2015,52(2):267-275.

[10] Chinese Society of Diabetes,Chinese Medical Association.Guidelines for the prevention and treatment of type 2 diabetes in China(version 2017)[J]. Chin J Diabetes,2018,10(1):4-67.(in Chinese)中华医学会糖尿病学分会．中国2型糖尿病防治指南(2017年版)[J]．中华糖尿病杂志，2018,10(1):4-67.

[11] QIU YP,ZHANG YC,XU YH. Study on the influence of changes in blood levels of HbAlc on hypertension and coronary heart disease in patients with diabetes mellitus[J]. J Clin Exp Med,2018,17(2):166-169.(in Chinese)邱永平，张运超，徐悦和．糖尿病患者糖化血红蛋白水平变化对高血压及冠心病的临床影响分析[J]．临床和实验医学杂志，2018,17(2):166-169.

[12] KO MC. A cohort study of age and sex specific risk of pyogenic liver abscess incidence in patients with type 2 diabetes mellitus[J]. Medicine(Baltimore),2019,98(17):e15366.

[13] LAI YR. HbA1C variability is strongly associated with the severity of peripheral neuropathy in patients with type 2 diabetes[J]. Front Neurosci,2019,13:90.

[14] ZHANG J. Comparison of clinical characteristics and outcomes of pyogenic liver abscess patients <65 years of age versus>/=65 years of age[J]. BMC Infect Dis,2019,19(1):233.

[15] LEE CR. Antimicrobial resistance of hypervirulent klebsiella pneumoniae:Epidemiology, hypervirulence-associated determinants,and resistance mechanisms[J]. Front Cell Infect Microbiol,2017,7:483.

[16] SHANKAR C,VEERARAGHAVAN B. Whole genome analysis of hypervirulent Klebsiella pneumoniae isolates from community and hospital acquired bloodstream infection[J]. BMC Microbiol,2018,18(1):6.

[17] JUN JB. Klebsiella pneumoniae liver abscess[J]. Infect Chemother,2018,50(3):210-218.

[18] CHEN F,ZHANG YT,QIAO HJ,et al. Clinical features of Klebsiella pneumoniae liver abscess[J]. J Clin Hepatol,2016,32(4):764-768.(in Chinese)陈帆，张艳亭，乔慧捷，等．肺炎克雷伯菌肝脓肿的临床特征分析[J]临床肝胆病杂志，2016,32(4):764-768.

[19] HUANG Y. Research advances in diagnosis and treatment of bacterial liver abscess[J]. J Clin Hepatol,2018,34(3):641-644.(in Chinese)黄洋．细菌性肝脓肿的诊治进展[J]．临床肝胆病杂志，2018,34(3):641-644.

施引文献

期刊类型引用(11)

1.	杨宸，郭寿贵，吴欣宇，卓楚. C反应蛋白与白蛋白比值对糖尿病合并细菌性肝脓肿患者预后的价值. 浙江医学. 2023(02): 150-153+158 . 百度学术
2.	朱国方，高俊，沈琦. 糖尿病合并肝脓肿患者血糖控制水平与临床及CT影像特征相关性分析. 中国现代医生. 2023(30): 47-50+55 . 百度学术
3.	雪洲. 探究生化检验用于糖尿病临床诊断的价值. 人人健康. 2022(06): 108-110 . 百度学术
4.	夏杰，别玉坤，杨成林，冯以斌，张友满，王治伟，徐初锋. 2型糖尿病与非糖尿病合并细菌性肝脓肿患者实验室指标变化对诊断及疗效的预测价值. 海南医学. 2022(11): 1391-1394 . 百度学术
5.	岳玲. 糖尿病并发深部脓肿的危险因素与临床特点分析. 基层医学论坛. 2022(17): 44-46 . 百度学术
6.	丁松，陈烨，刘慧娇. 脓毒血症患者不同血糖水平的临床特征及预后分析. 中外医疗. 2022(16): 63-66 . 百度学术
7.	封立魁，杜国盛. 缓症链球菌肝脓肿1例报告. 临床肝胆病杂志. 2021(02): 408-410 . 本站查看
8.	唐杰，于永敏，班丽芳，侯淑芬，陆文婷. 细菌性肝脓肿患者引流液细菌培养及药敏试验结果分析. 潍坊医学院学报. 2021(02): 149-151 . 百度学术
9.	郑伟，陈竹凤，杨文韬，陈凝. 细菌性肝脓肿合并血流感染的临床特点及其相关危险因素分析. 中外医学研究. 2021(13): 41-44 . 百度学术
10.	张树霞. 糖化血红蛋白检验应用在糖尿病诊治中的准确性及意义. 糖尿病新世界. 2021(09): 26-29 . 百度学术
11.	张瑞梅. 细菌性肝脓肿患者引流液细菌培养及药敏试验结果分析. 中国民康医学. 2021(12): 98-100 . 百度学术