Drug resistance of Enterobacteriaceae bacteria causing liver abscess

Zhou YiQing; Ceng Min; Zhou Jie; Ruan YongChun; Zhang HaiWang; Su MeiXia; He Wei; Li MingHui

doi:10.3969/j.issn.1001-5256.2018.08.031

Issue 8

Aug. 2018

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2018 > 34(8): 1750-1753

PDF( 1798 KB)

Drug resistance of Enterobacteriaceae bacteria causing liver abscess

DOI: 10.3969/j.issn.1001-5256.2018.08.031

Department of Infectious Diseases, Shaoxing People's Hospital

Research funding:

Received Date: 2018-03-01
Published Date: 2018-08-20

Abstract

Abstract

Objective To investigate the drug resistance of Enterobacteriaceae bacteria which cause liver abscess, and to guide the application of antibiotics. Methods The patients with liver abscess who were hospitalized in our hospital from January 2014 to December 2017 and were found to have Enterobacteriaceae bacteria by isolation were enrolled as research subjects. Their clinical data, laboratory examination results, drug resistance data, treatment method, and outcomes were analyzed. Results Among the 53 patients, 28 ( 52. 8%) had gallbladder and biliary diseases or a surgical history, 20 ( 37. 7%) had hypertension, and 18 ( 34. 0%) had diabetes; as for clinical manifestations, 51 ( 96. 2%) had pyrexia, 33 ( 62. 3%) had liver pain or gastrointestinal symptoms, and 6 ( 11. 3%) had septic shock. Among these patients, 31 ( 58. 5%) had a leukocyte count of > 10 × 109/L, 37 ( 69. 8%) had an increase in neutrophil count, 50 ( 94. 3%) had an increase in C-reactive protein, 32 ( 60. 4%) had an increase in alanine aminotransferase, and 22 ( 41. 5%) had an increase in aspartate aminotransferase; among the 19 patients who underwent procalcitonin ( PCT) measurement, 17 ( 89. 5%) were found to have an increase in PCT. A total of 11 patients had a positive blood culture, among whom 7 ( 63. 6%) had Klebsiella pneumoniae and 4 ( 36. 4%) had Escherichia coli. Pus or bile culture identified Enterobacteriaceae bacteria strains in the 53 patients, among whom 35 ( 66. 0%) had Klebsiella pneumoniae, 12 ( 22. 6%) had Escherichia coli, 2 ( 3. 8%) had Morganella morganii subspecies, and 1 ( 1. 9%) each had Proteus penneri, Providencia rustigianii, Citrobacter freundii, and Proteus mirabilis. Among the 35 patients with Klebsiella pneumoniae, 2 had extended-spectrum beta-lactamase ( ESBL) -producing Klebsiella pneumoniae, and among the 12 patients with Escherichia coli, 9 had ESBL-producing Escherichia coli; Klebsiella pneumoniae strains were sensitive to common antibiotics, while Escherichia coli strains had high drug resistance rates to second-and third-generation cephalosporins, quinolones, and aminoglycosides. All isolates were highly sensitive to carbapenems. Conclusion Enterobacteriaceae bacteria causing liver abscess has a low ESBL-positive rate. Third-generation cephalosporins and antibiotics containing β-lactamase inhibitors are major regimens for initial empiric therapy.
- liver abscess,
- klebsiella pneumoniae,
- escherichia coli,
- drug resistance,
- therapeutics

FullText(HTML)

胰十二指肠切除术(pancreaticoduodenectomy，PD)目前是治疗胆胰汇合部周围恶性肿瘤及部分良性疾病的唯一根治性手术方式。但是其手术范围广，创伤较大，故术后并发症多。其中，胃排空延迟(delayed gastric emptying，DGE)患者术后禁食时间延长，恢复慢，并且严重影响了患者术后的生活质量。近年有研究^[1-2]表明，Braun吻合(Braun anastomosis，BE)可降低PD术后DGE的发生率，但尚存在争议^[3-5]。Braun手术始于1892年，Braun对胃切除术后出现严重反流性胃食管炎的患者进行二次手术，在连接残胃的空肠输入段和输出段之间进行了肠肠吻合，以降低术后胆汁性胃炎和胆汁性呕吐的发生，并建议在胃肠吻合术后常规进行该吻合，或可以降低术后吻合口瘘及输入袢梗阻的发生率^[6]。理论上BE可以使胆汁和胰液等消化液通过BE口排出，减少对胃黏膜的刺激。亦可通过该吻合口排出部分胃内容物，减少潴留^[7]。也有学者^[1-2]认为可防止肠道扭转并维持消化道稳定，并通过减少胃肠道压力降低胰瘘发生率，进而减少DGE的发生。因此本研究的目的是进一步明确BE对预防PD术后DGE的影响。

1. 资料及方法

1.1 研究对象

收集2016年12月—2019年12月在兰州大学第一医院行根治性PD的患者资料。根据术中是否行BE将患者分为BE组和非BE组。收集患者的性别、年龄、BMI、病理分型、基础疾病、WBC、RBC、PLT、Hb、ALT、AST、TBil、Alb、手术时间、出血量、术后并发症、止吐及通便药物使用次数、第1次化疗时间(术后)、住院时长及住院花费。

1.2 纳入和排除标准

纳入标准：(1)20~80岁。(2)临床上确诊胆胰汇合部周围恶性肿瘤及部分良性疾病，并经多学科会诊后，建议行PD的患者。(3)DGE诊断标准参考《胰腺术后外科常见并发症诊治及预防的专家共识(2017)》^[9]，术后3 d因仍需要气管插管而留置胃管等其他非胃排空功能减弱的情况，同时上消化道造影证实未见胃蠕动波并伴有胃扩张时，出现以下情况之一者，可诊断为术后DGE：①术后需置胃管时间超过3 d；②拔管后因呕吐等原因再次置管；③术后7 d仍不能进食固体食物。根据其严重程度分为A、B、C 3级。A级：鼻胃管(nasogastric tube，NGT)时间大于术后3 d，或术后7 d不能耐受固体饮食，可伴呕吐，可能需要应用促胃肠动力药物。B级：NGT时间术后8~14 d，或术后7 d后重插NGT或术后14 d仍不能耐受固体饮食；伴呕吐，需要应用促胃肠动力药物。C级：NGT时间大于术后14 d，或术后14 d后重插，或不能耐受固体饮食时间大于术后21 d，伴呕吐，需要应用促胃肠动力药物。(4)胰瘘、胆瘘、出血等并发症诊断标准参考《胰腺术后外科常见并发症诊治及预防的专家共识(2017)》^[9]。

排除标准：(1)幽门及其他消化道梗阻吻合口狭窄、吻合口水肿等；(2)胃癌；(3)既往有消化道改建手术史；(4)保留幽门的PD；(5)伴有严重并发症不能耐受手术者；(6)拒绝签署知情同意书者；(7)资料不全者。

1.3 手术方法

两组患者均行开腹PD，采用标准的术式，切除范围包括胰头(包括钩突部)、肝总管以下胆管(包括胆囊)、远端胃、十二指肠及部分空肠，同时清扫胰头周围、肠系膜血管根部，横结肠系膜根部以及肝总动脉周围和肝十二指肠韧带内淋巴结。重建按照胰腺-空肠吻合、肝总管-空肠吻合和胃-空肠吻合顺序进行^[8]。BE组：于胃肠吻合口10 cm处，将连接残胃空肠的输入端与输出端使用直线切割闭合器行空肠-空肠侧侧吻合，吻合口直径2 cm。两组患者术后均常规于胆肠吻合口、胰肠吻合口各放置1根腹腔引流管，胃肠减压管1根，鼻肠营养管1根。

1.4 伦理学审查

本研究方案经由兰州大学第一医院伦理委员会审批，批号：LDYYLL2021-12，所纳入患者均已签署知情同意书。

1.5 统计学方法

采用SPSS 26.0统计学软件进行分析。符合正态分布的计量资料以x±s表示，两组间比较采用独立样本t检验；非正态分布的计量资料以M(P₂₅~P₇₅)表示，两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验或Fisher精确检验。P＜0.05为差异有统计学意义。

2. 结果

2.1 一般资料

共纳入132例患者，胰头恶性肿瘤41例，良性疾病10例，胆管下段胆管癌43恶性肿瘤，良性1例，壶腹部恶性肿瘤12例，十二指肠恶性肿瘤25例。合并高血压者29例，合并糖尿病者26例。两组患者的性别、年龄、BMI、术前WBC、RBC、PLT、Hb、ALT、AST、TBil、Alb，糖尿病高血压病史以及病理分型，差异均无统计学意义(P值均＞0.05)(表 1)。

表 1 两组患者一般资料比较

指标	BE组(n=54)	非BE组(n=78)	统计值	P值
男/女(例)	33/21	46/32	χ²=0.061	0.806
年龄(岁)	62.0(53.5~66.0)	56.0(50.0~67.0)	H=-1.565	0.118
BMI(kg/m²)	23.21±2.92	22.62±3.36	t=1.032	0.304
WBC(×10⁹/L)	5.71(4.59~7.55)	5.75(4.46~7.10)	H=-0.429	0.466
RBC(×10¹²/L)	4.38±0.60	4.32±0.66	t=0.559	0.577
PLT(×10⁹/L)	236.76±85.30	218.69±73.30	t=1.301	0.195
Hb(g/L)	133.56±3.06	133.55±2.53	t=0.001	0.999
ALT(U/L)	133.00(43.75~254.00)	115.00(40.50~245.00)	H=-0.206	0.837
AST(U/L)	117.50(35.50~201.25)	79.00(38.50~183.50)	H=-0.818	0.413
TBil(μmol/L)	153.60(22.43~280.40)	134.60(20.35~238.95)	H=-0.727	0.467
Alb(g/L)	41.30(37.68~43.48)	40.60(38.05~43.35)	H=-0.388	0.698
糖尿病(例)	11	15	χ²=0.026	0.871
高血压(例)	12	17	χ²=0.003	0.954
病理分型[例(%)]
胰头恶性肿瘤	16(29.63)	25(32.05)	χ²=0.087	0.768
胰头良性疾病	4(7.41)	6(7.69)	χ²=0	1.000
胆管下段恶性肿瘤	17(31.4)	26(33.33)	χ²=1.643	0.896
胆管下段良性疾病	1(1.85)	0		0.409
壶腹部恶性肿瘤	5(9.26)	7(8.97)	χ²=0.000	1.000
十二指肠恶性肿瘤	11(20.37)	14(17.95)	χ²=0.122	0.727
出血量(ml)	300.00(200.00~400.00)	200.00(187.75~400.00)	H=-0.655	0.512
手术时长(min)	400(300~530)	360(320~430)	H=-0.838	0.402

下载: 导出CSV

| 显示表格

2.2 术中出血量及手术时间比较

所有患者均顺利完成手术。两组患者在出血量及手术时长上均无明显差异(P值均＞0.05)(表 1)。

2.3 术后第1天生化指标比较

术后第1天，两组患者常规检验指标中BE组WBC水平高于BE组(H=-2.402，P=0.016)，其他指标两组差异均无统计学意义(P值均＞0.05)(表 2)。

表 2 术后第1天生化指标、并发症及DGE发生率比较

指标	BE组(n=54)	非BE组(n=78)	统计值	P值
WBC(×10⁹/L)	14.29(11.40~18.23)	11.65(9.87~15.98)	H=-2.402	0.016
RBC(×10¹²/L)	3.76(3.38~4.02)	3.75(3.43~4.09)	H=-0.157	0.875
PLT(×10⁹/L)	223.98±81.30	210.21±83.25	t=0.944	0.347
Hb(g/L)	115.00(104.75~125.00)	115.50(103.00~126.00)	H=-0.190	0.849
AST(U/L)	76.50(52.75~120.25)	84.00(58.50~121.00)	H=-0.310	0.756
ALT(U/L)	93.00(49.75~150.50)	91.50(52.00~155.75)	H=-0.245	0.806
TBil(μmol/L)	101.10(25.60~162.45)	76.20(22.70~159.00)	H=-0.461	0.645
Alb(g/L)	30.00±3.88	31.25±3.61	t=-1.907	0.059
并发症[例(%)]
出血	9(16.67)	11(14.10)	χ²=0.163	0.686
DGE	50(92.59)	65(83.33)	χ²=2.438	0.118
胰瘘(B+C级)	6(11.11)	18(23.08)	χ²=3.071	0.081
胆瘘	3(5.56)	6(7.69)	χ²=0.016	0.898
胃肠瘘	1(1.85)	3(3.85)		0.644
伤口感染	4(7.41)	10(12.82)	χ²=0.986	0.321
伤口裂开	0	2(2.56)		0.513
腹腔感染	14(25.93)	17(21.79)	χ²=0.303	0.582
肠梗阻	1(1.85)	4(5.13)		0.648
DGE发生率[例(%)]
A级	27(50.00)	31(39.74)		＞0.05
B级	20(37.04)	19(24.36)		＞0.05
C级	3(5.56)	15(19.23)		＜0.05
总体	50(92.59)	65(83.33)	χ²=2.438	＞0.05

下载: 导出CSV

| 显示表格

2.4 术后并发症比较

与非BE组相比，BE组C级DGE发生率较低(P＜0.05)。其他并发症如出血、胰瘘(B+C级)、胃肠瘘、切口感染、伤口裂开、腹腔感染、肠梗阻及A级、B级、总体DGE生率均无明显差异(P值均＞0.05)(表 2)。

2.5 术后其他治疗指标比较

与非BE组患者相比，BE组患者止吐药物使用次数少，术后住院时间短，化疗开始时间早，差异均有统计学意义(P值均＜0.05)。在胃管持续时间、恢复饮食时间、住院费用方面两组差异均无统计学意义(P值均＞0.05)(表 3)。

表 3 术后其他治疗指标

指标	BE组(n=54)	非BE组(n=78)	H值	P值
胃管持续时间(d)	7.00(5.75~9.00)	7.00(5.00~11.25)	-0.081	0.935
恢复饮食时间(d)	9.00(7.00~12.00)	11.00(8.00~17.25)	-1.709	0.087
止吐药物使用次数(次)	1.00(0~0.25)	1.00(1.00~4.00)	-2.347	0.019
第1次化疗时间(d)	45.00(38.00~49.75)	53.00(44.00~65.00)	-2.495	0.013
术后住院时长(d)	15.00(12.75~19.25)	18.00(15.00~25.50)	-3.358	0.004
住院费用(元)	70 303.90(56 620.84~94 435.69)	78 455.30(67 485.51~97 124.42)	-1.911	0.056

下载: 导出CSV

| 显示表格

3. 讨论

目前研究认为PD术后DGE的具体病因尚未明确，多数研究支持可能与以下多种因素有关：促胃动素分泌的减少^[10-11]、胃节律的破坏^[12]、胃黏膜受反流性胆汁的刺激^[13]、鸭爪神经损毁以及幽门切除丧失了对胃排出功能的约束，减少了胆汁反流入胃的阻碍^[14-15]、吻合口狭窄或水肿^[16]、术前合并糖尿病^[17]、术后并发症如：胰瘘、胆瘘、腹腔内感染^[18]、精神心理因素^[19]等诸多因素的影响。

而BE在理论上可能降低PD术后DGE的发生，故近些年部分研究者^{[1-4, 7]}将BE引入PD中。有研究^{[1-2, 7, 20]}发现，BE方式可以降低PD术后DGE、碱性反流性胃炎或边缘性溃疡的发生。部分研究^{[7, 21]}甚至报道其降低了胰瘘的发生率。在Hochwald等^[7]的研究中，BE组在DGE总体发生率、尽早拔除胃管、尽早进食、尽早出院等方面与非BE组有统计学差异，而临床相关的DGE(B级+C级)差异更加明显(7% vs 31%，P＜0.01)。Xu等^[2]研究发现，BE组DGE发生率显著降低(6.7% vs 26.87%，P＜0.001)，且多因素分析显示BE是唯一的独立危险因素；同时BE组有着更低的临床胰瘘发生率(P＜0.001)。Meng等^[1]研究显示，胰腺残端连续缝合加BE能显著降低DGE(P＜0.01)及临床相关PF发生率(P＜0.05)，但是该实验未能明确BE在结果中的具体作用，亦有可能是连续缝合降低了胰瘘的发生进而降低DGE的发生。部分循证学研究^[22]同样支持BE可降低DGE发生率的观点。但是不同研究之间在重建消化道距离(BE口与胃肠吻合口)和BE吻合口径上不一致，并在术后治疗和护理方案上均存在差^{[1-4, 7]}，部分研究^[3-4]结果并不支持BE可以降低DGE发生率的观点。

本研究中，BE减少了C级DGE的发生，与Xu等^[2]的研究结果不同。本研究两组患者在DGE总体发病率上未表现出明显差异，这可能与本中心拔除胃管时间较晚，导致A级DGE占比(50.43%)较大有关。在目前PD手术加速康复外科理念的实施中，常规术后第2天拔除胃管^[23]，而本回顾性研究未施行加速康复外科理念治疗策略，术后胃管持续时间大多超过3 d，故按照本研究采用的诊断标准，总体DGE发生率明显高于同期国内水平^[24]。在临床上C级DGE患者术后呕吐症状较明显，止吐药物使用次数较多，故在本研究中，BE在降低了C级DGE的发生率的同时，亦降低了术后止吐药物的使用次数。除此之外，BE组患者术后住院时间较短，这可能与C级DGE患者住院时间较长，而BE组C级DGE患者明显较少有关。

由于本回顾性研究在单一机构的局限性，未来还需更大样本的前瞻性研究，统一手术步骤及术后治疗护理方案，并在BE口径以及与胃肠吻合的距离上进行更进一步的探索。

References(15)

References

[1]CHEN F, ZHANG YT, QIAO HJ, et al.Clinical fealthers of klebsiella pneumoniae liver abscess[J].J Clin Hepatol, 2016, 32 (4) :746-768. (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) :746-768.

[2]TIAN L, CHEN ZJ, SUN ZY, et al.Antibiotic resistance profile of Enterobacter in hospitals across China:Data from CHINET antimicrobial resistance surveillance program from 2005 through 2014[J].Chin J Infect Chemother, 2016, 16 (3) :275-283. (in Chinese) 田磊, 陈中举, 孙自镛, 等.2005-2014年CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志, 2016, 16 (3) :275-283.

[3]XU A, ZHUO C, SU DH, et al.Changing susceptibility of Klebsiella strains in hospitals across China:Data from the CHINET antimicrobial resistance surveillance program, 2005-2014[J].Chin J Infect Chemother, 2016, 16 (3) :267-274. (in Chinese) 徐安, 卓超, 苏丹虹, 等.2005-2014年CHINET克雷伯菌属细菌耐药性监测[J].中国感染与化疗杂志, 2016, 16 (3) :267-274.

[4]LI XJ, WANG B, XIONG H.Clinical characteristics and bacterial distribution in patients with diabetes companied with pyogenic hepatic abscess[J].Chin J Clin Pharmacol, 2015, 31 (3) :232-234. (in Chinese) 李晓晶, 汪波, 熊辉.糖尿病合并肝脓肿的临床特点及其感染细菌分布[J].中国临床药理学杂志, 2015, 31 (3) :232-234.

[5]ZHANG TT, YUAN Z.Analysis on distribution of bacterial etiology and drug resistance of pyogenic liver abscess[J].Med J West China, 2017, 29 (5) :679-684. (in Chinese) 张婷婷, 袁喆.细菌性肝脓肿病原学分布及耐药性分析[J].西部医学, 2017, 29 (5) :679-684.

[6]PERIS J, BELLOT P, ROIG P, et al.Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65:A retrospective study[J].BMC Geriatr, 2017, 17 (1) :161.

[7]CHO H, LEE ES, LEE YS, et al.Predictors of septic shock in initially stable patients with pyogenic liver abscess[J].Scand J Gastroenterol, 2017, 52 (5) :589-594.

[8] ZHOU YQ, ZHOU J, ZENG M, et al.The clinical features of 93bacterial liver abscess cases[J].J Chin Physician, 2017, 19 (10) :1524-1527. (in Chinese) 周宜庆, 周洁, 曾敏, 等.93例细菌性肝脓肿患者临床特征分析[J].中国医师杂志, 2017, 19 (10) :1524-1527.

[9]FAZILI T, SHAMGOE C, ENDY T, et al.Klebsiella pneumoniae liver abscess:An emerging disease[J].Am J Med Sci, 2016, 351 (3) :297-304.

[10]FUNG CP, CHANG FY, LEE SC, et al.A global emerging disease of Klebsiella pneumoniae liver abscess:Is serotype K1 an important factor for complicated endophthalmitis?[J].Gut, 2002, 50 (3) :420-424.

[11]LEE IR, MOLTON JS, WYRES KL, et al.Differential host susceptibility and bacterial virulence factors driving Klebsiella liver abscess in an ethnically diverse population[J].Sci Rep, 2016, 6:29316.

[12] National Health and Family Planning Commission Medical and Health Authority.Notice of the General Office of the Health and Family Planning Commission of the People's Republic of China on Further Strengthening the Management of Antibiotics for Clinical Applications to Control Bacterial Resistance[R/OL].http://www.nhfpc.gov.cn/yzygj/s7659/201703/d2f580480cef4ab1b976542b550f36cf.shtml, 2017. (in Chinese) 国家卫计委医政医管局.国家卫生计生委办公厅关于进一步加强抗菌药物临床应用管理遏制细菌耐药的通知[R/OL].http://www.nhfpc.gov.cn/yzygj/s7659/201703/d2f580480cef4ab1b976542b550f36cf.shtml, 2017.

[13]MAVILIA MG, MOLINA M, WU GY.The Evolving nature of hepatic abscess:A review[J].J Clin Transl Hepatol, 2016, 4 (2) :158-168.

[14]HAIDER SJ, TARULLI M, MCNULTY NJ, et al.Liver abscesses:Factors that influence outcome of percutaneous drainage[J].AJR Am J Roentgenol, 2017, 209 (1) :205-213.

[15]RISMILLER K, HAAGA J, SIEGEL C, et al.Pyogenic liver abscesses:A contemporary analysis of management strategies at a tertiary institution[J].HPB (Oxford) , 2017, 19 (10) :889-893.

Relative Articles

[1]	Meng LU, Mingjie WANG, Li CHEN. Advances in the application of elastography in noninvasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2023, 39(2): 408-412. doi: 10.3969/j.issn.1001-5256.2023.02.025
[2]	Zhiran YANG, Linheng WANG, Yuan LI, Fusheng LIU, Yu WANG, Jianfang WANG, Runhua CHEN. Diagnostic value of transient elastography in the staging of hepatic fibrosis in patients with autoimmune liver disease: A Meta-analysis[J]. Journal of Clinical Hepatology, 2022, 38(1): 97-103. doi: 10.3969/j.issn.1001-5256.2022.01.015
[3]	Qiao HE, Wencong YUAN, Haining FAN, He XU, Bin REN. Current status of research on elastography combined with serology in the diagnosis of chronic hepatitis B liver fibrosis[J]. Journal of Clinical Hepatology, 2021, 37(12): 2914-2918. doi: 10.3969/j.issn.1001-5256.2021.12.037
[4]	Mingjie YAO, Xiajie WEN, Leijie WANG, Qiong HE, Jianwen LUO, Jiangao FAN, Qing XIE, Chengwei CHEN, Qing Chun FU, Jun Ping SHI, Yongfeng YANG, Yun XU, Lungen LU, Fengmin LU. Establishment of a model for evaluating the severity of nonalcoholic fatty liver disease based on transient elastography parameters[J]. Journal of Clinical Hepatology, 2021, 37(7): 1614-1618. doi: 10.3969/j.issn.1001-5256.2021.07.027
[5]	Kaimin SONG, Jun LIU. Advances in the application of transient elastography in chronic hepatitis B[J]. Journal of Clinical Hepatology, 2021, 37(2): 419-424. doi: 10.3969/j.issn.1001-5256.2021.02.036
[6]	Xu ZhiQiang, Dong Yi, Wang FuChuan, Wang LiMin, Yan JianGuo, Cao LiLi, Wang Pu, Li AiQin, Zhong YanWei, Zhang Min. Value of transient elastography in the diagnosis of liver fibrosis in chronic hepatitis B children of different ages[J]. Journal of Clinical Hepatology, 2020, 36(6): 1268-1272. doi: 10.3969/j.issn.1001-5256.2020.06.016
[7]	SUN YiFei, HUANG LiPing. Noninvasive evaluation of esophageal and gastric varices in liver cirrhosis by shear-wave ultrasound elastography[J]. Journal of Clinical Hepatology, 2020, 36(12): 2815-2818. doi: 10.3969/j.issn.1001-5256.2020.12.036
[8]	Zhang DaKun, Chen Min, Zhang WenHui, Wang RuiFang, Shi XiaoJuan. Clinical value of acoustic radiation force impulse elastography in predicting esophageal variceal bleeding in liver cirrhosis[J]. Journal of Clinical Hepatology, 2020, 36(3): 561-564. doi: 10.3969/j.issn.1001-5256.2020.03.018
[9]	Liu LinXiang, Nie Yuan, Zhu Xuan. Clinical application of transient elastography in liver cirrhosis and its complications[J]. Journal of Clinical Hepatology, 2020, 36(6): 1362-1365. doi: 10.3969/j.issn.1001-5256.2020.06.037
[10]	Chen WeiTing, Li ShuangJie. Clinical value of transient elastography,aspartate aminotransferase-to-platelet ratio index,and fibrosis-4 in the diagnosis of liver fibrosis in children with biliary atresia[J]. Journal of Clinical Hepatology, 2020, 36(3): 546-550. doi: 10.3969/j.issn.1001-5256.2020.03.015
[11]	Luo WenPing, Ma Hong, Wang Yu. Advances in the application of transient elastography in noninvasive diagnosis of liver fibrosis[J]. Journal of Clinical Hepatology, 2019, 35(3): 635-639. doi: 10.3969/j.issn.1001-5256.2019.03.041
[12]	Xu FengMing, Sheng QingShou. Research advances in serum markers and transient elastography in the evaluation of liver fibrosis[J]. Journal of Clinical Hepatology, 2018, 34(3): 618-622. doi: 10.3969/j.issn.1001-5256.2018.03.040
[13]	Dong Xue, Huang LiPing. Research advances in the value of ultrasound elastography in the diagnosis of gastroesophageal varices in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2018, 34(11): 2424-2427. doi: 10.3969/j.issn.1001-5256.2018.11.035
[14]	Zhuang XiaoFang, Sun Jie, Wang XiaoBo, Wang Yan, Wu QiQi, Wang XiaoZhong. Performance of transient elastography in diagnosis of nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2017, 33(12): 2366-2371. doi: 10.3969/j.issn.1001-5256.2017.12.022
[15]	Ge Na, He Qian. Ultrasound elastography for evaluation of classification of liver fibrosis[J]. Journal of Clinical Hepatology, 2016, 32(12): 2379-2382. doi: 10.3969/j.issn.1001-5256.2016.12.032
[16]	Yang MingLei, Yao DingKang. Application of magnetic resonance elastography as a non-invasive technique for diagnosis of liver fibrosis[J]. Journal of Clinical Hepatology, 2016, 32(3): 588-592. doi: 10.3969/j.issn.1001-5256.2016.03.042
[17]	Li Mi, Nie QingHe. The progress of Fibro Scan technique for diagnosis of hepatocellular carcinoma value[J]. Journal of Clinical Hepatology, 2015, 31(6): 969-973. doi: 10.3969/j.issn.1001-5256.2015.06.035
[18]	Zhou JiaLing, Wei Wei, You Hong. Progress in clinical studies of noninvasive early diagnosis of liver fibrosis and cirrhosis[J]. Journal of Clinical Hepatology, 2014, 30(7): 604-607. doi: 10.3969/j.issn.1001-5256.2014.07.007
[19]	Zhang GuoSheng, Wang TianYi, Xu YouQing, Zhou Li, Geng Nan, Chen Yu. Diagnostic value of real-time tissue elastography for liver fibrosis in patients with chronic hepatitis B[J]. Journal of Clinical Hepatology, 2014, 30(7): 616-619. doi: 10.3969/j.issn.1001-5256.2014.07.010
[20]	Chen Fei, Yao YaNing, Ma SuMei, Feng Fei, Zou Quan, Xue LiLi. Diagnostic value of acoustic radiation force impulse in patients with non- alcoholic simple fatty liver[J]. Journal of Clinical Hepatology, 2013, 29(10): 756-759. doi: 10.3969/j.issn.1001-5256.2013.10.009

Supplements(0)

Cited By

Cited by

Periodical cited type(3)

1.	粟雨萌，张鸣杰，谈振华，谢平. 胰十二指肠切除术后发生胃排空延迟的危险因素分析. 肝胆胰外科杂志. 2024(10): 608-611+616 .
2.	张苗苗，白纪刚，张东，雷建军，耿智敏，冯爱芳，董芳芳，史爱华，吕毅，严小鹏. 用于胰十二指肠切除术中Braun吻合磁环的设计及临床应用. 中国医疗设备. 2022(06): 8-11 .
3.	李利平，游意莹，沈宁，曹宏，王艳玲. 改良内陷式胰肠吻合在胰十二指肠切除术中的应用. 中华肝脏外科手术学电子杂志. 2022(05): 458-462 .

Other cited types(0)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (2225) PDF downloads(387)

Drug resistance of Enterobacteriaceae bacteria causing liver abscess

DOI: 10.3969/j.issn.1001-5256.2018.08.031