Chen Shiuan-Chih, Lee Yuan-Ti, Lai Kuang-Chi, Cheng Ken-Sheng, Jeng Long-Bin, Wu Wei-Ya, Chen Chun-Chien, Lee Meng-Chih
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Swiss Med Wkly. 2006 Feb 18;136(7-8):119-26. doi: 10.4414/smw.2006.11341.
The aim of this study was to identify the risk factors for developing extra-hepatic metastases from pyogenic liver abscesses.
We conducted a retrospective study and reviewed 225 patients (age, 19-93 years) with a discharge diagnosis of pyogenic liver abscess from a large medical centre in Taiwan, between January 1995 and June 2000. Clinical data were collected from medical records. Of the 225 patients with a pyogenic liver abscess, 24 had extrahepatic metastases and were classified into the metastatic infection group; the remaining 201 were classified into the non-metastatic infection group and served as the control group. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by exact logistic regression.
After adjustment for age, sex, and the duration of symptoms before admission, diabetes mellitus (adjusted OR, 12; 95% CI, 3.3-67), alcoholism (adjusted OR, 5.2; 95% CI, 1.4-20), the time interval >7 days from the onset of symptoms to the time appropriate antibiotics were administered (adjusted OR, 3.9; 95% CI, 1.2-13), bacteraemia (adjusted OR, 5.4; 95% CI, 1.4-30), and infection (adjusted OR, 5.0; 95% CI, 1.1-47) were associated with the development of extra-hepatic metastases from pyogenic liver abscesses. On the other hand, fever (adjusted OR, 0.28; 95% CI, 0.089-0.92) and right upper quadrant pain/tenderness (adjusted OR, 0.091; 95% CI, 0.0020-0.50) were associated with the non-metastatic abscesses. We performed a multivariate analysis and found that diabetes mellitus (multivariate OR, 7.7; 95% CI, 2.1-29) and alcoholism (multivariate OR, 8.9; 95% CI, 2.6-30) were the independent risk factors for developing metastatic infections; yet right upper quadrant pain/tenderness (multivariate OR, 0.11; 95% CI, 0.014-0.87) was the predictor of no metastatic abscesses.
Our data suggest that diabetes mellitus and alcoholism are significant risk factors for developing metastatic infections from pyogenic liver abscesses. These findings seem to imply that underlying conditions of the host influence the development of extra-hepatic metastases from pyogenic liver abscesses.
本研究旨在确定化脓性肝脓肿发生肝外转移的危险因素。
我们进行了一项回顾性研究，回顾了1995年1月至2000年6月间台湾一家大型医疗中心出院诊断为化脓性肝脓肿的225例患者（年龄19 - 93岁）。临床数据从病历中收集。在225例化脓性肝脓肿患者中，24例发生肝外转移，被归入转移性感染组；其余201例被归入非转移性感染组作为对照组。通过精确逻辑回归计算比值比（OR）和95%置信区间（CI）。
在对年龄、性别和入院前症状持续时间进行调整后，糖尿病（调整后OR，12；95%CI，3.3 - 67）、酗酒（调整后OR，5.2；95%CI，1.4 - 20）、症状出现至使用适当抗生素的时间间隔>7天（调整后OR，3.9；95%CI，1.2 - 13）、菌血症（调整后OR，5.4；95%CI，1.4 - 30）和感染（调整后OR，5.0；95%CI，1.1 - 47）与化脓性肝脓肿发生肝外转移有关。另一方面，发热（调整后OR，0.28；95%CI，0.089 - 0.92）和右上腹疼痛/压痛（调整后OR，0.091；95%CI，0.0020 - 0.50）与非转移性脓肿有关。我们进行了多因素分析，发现糖尿病（多因素OR，7.7；95%CI，2.1 - 29）和酗酒（多因素OR，8.9；95%CI，2.6 - 30）是发生转移性感染的独立危险因素；然而右上腹疼痛/压痛（多因素OR，0.11；95%CI，0.014 - 0.87）是无转移性脓肿的预测因素。
我们的数据表明，糖尿病和酗酒是化脓性肝脓肿发生转移性感染的重要危险因素。这些发现似乎意味着宿主的基础状况影响化脓性肝脓肿肝外转移的发生。
