退伍军人人群中的胆结石疾病谱

Spectrum of gallstone disease in the veterans population.

作者信息

Stewart Lygia, Griffiss J McLeod, Way Lawrence W

机构信息

Department of Surgery, University of California San Francisco, San Francisco, CA, USA.

出版信息

Am J Surg. 2005 Nov;190(5):746-51. doi: 10.1016/j.amjsurg.2005.07.014.

DOI:10.1016/j.amjsurg.2005.07.014

PMID:16226952

Abstract

BACKGROUND

Elderly male patients are thought to have a higher incidence of biliary infections. This demographic is common among veterans, so we analyzed the spectrum of gallstone disease in a large veteran population.

METHODS

A total of 285 patients with gallstone disease were studied. There were 27 women and 258 men, with an average age of 62 years. Gallstones, bile, and blood (as indicated) were cultured. Illness severity was staged as none (no clinical infection), moderate (fever, leukocytosis), or severe (cholangitis, bacteremia, abscess, hypotension, organ failure). Gallstones were grouped by appearance. Three bacterial groups were defined: EK (Escherichia coli or Klebsiella species), N (Enterococcus), or Oth (all other species).

RESULTS

Biliary bacteria were present in 145 (51%) patients. Bacterial presence by patient age was 33% for those less than 50 years, 48% for those 50 to 70 years, and 65% for those more than 70 years (P <.02 vs. others). Bacterial presence by stone type was as follows: cholesterol, 11%; mixed, 51%; pigment, 71% (P <.01 vs. others). Illness severity by stone type was as follows for cholesterol: none, 73%; moderate, 27%; severe, 0%; for mixed: none, 62%; moderate, 25%; severe, 13%; for pigment: none, 41%; moderate, 17%; severe, 41% (P <.0001 vs. others). Illness severity by bacterial group was as follows for sterile: none, 77%; moderate, 23%; severe, 0%; for the Oth group: none, 57%; moderate, 22%; severe, 20%; for the N group: none, 32%; moderate, 16%; severe, 52%; for the EK group: none, 18%; moderate, 22%; severe, 60% (P <.0001 vs. sterile/Oth, P = .126 vs. N).

CONCLUSIONS

Bacterial biliary tree colonization is prevalent in the veterans' population, it increases with age, and is more common with pigment stones. But not all bacterial species cause infectious manifestations. Patients with E coli and/or Klebsiella species commonly showed infectious manifestations, patients with Enterococcus were in an intermediate range, and those with other species had few infectious manifestations.

摘要

背景

老年男性患者被认为胆道感染发生率较高。这一人群在退伍军人中很常见，因此我们分析了一大群退伍军人中的胆结石疾病谱。

方法

共研究了285例胆结石疾病患者。其中女性27例，男性258例，平均年龄62岁。对胆结石、胆汁和血液（如有指征）进行培养。疾病严重程度分为无（无临床感染）、中度（发热、白细胞增多）或重度（胆管炎、菌血症、脓肿、低血压、器官衰竭）。胆结石按外观分组。定义了三个细菌组：EK（大肠杆菌或克雷伯菌属）、N（肠球菌）或其他（所有其他菌种）。

结果

145例（51%）患者存在胆道细菌。年龄小于50岁的患者细菌感染率为33%，50至70岁的患者为48%，70岁以上的患者为65%（与其他组相比，P<.02）。按结石类型划分的细菌感染情况如下：胆固醇结石为11%；混合性结石为51%；色素结石为71%（与其他结石相比，P<.01）。按结石类型划分的疾病严重程度如下：胆固醇结石：无，73%；中度，27%；重度，0%；混合性结石：无，62%；中度，25%；重度，13%；色素结石：无，41%；中度，17%；重度，41%（与其他结石相比，P<.0001）。按细菌组划分的疾病严重程度如下：无菌组：无，77%；中度，23%；重度，0%；其他组：无，57%；中度，2 %；重度，20%；N组：无，32%；中度，16%；重度，52%；EK组：无，18%；中度，22%；重度，60%（与无菌/其他组相比，P<.0001，与N组相比，P =.126）。