Ming-Jen Tsai, Ying C Huang, Chung Hsien Liu, Kai-Yuan Cheng, Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
World J Gastroenterol. 2017 Apr 28;23(16):2948-2956. doi: 10.3748/wjg.v23.i16.2948.
To investigate the association between a recent gastrointestinal (GI) endoscopy and the subsequent risk of pyogenic liver abscess (PLA).
We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date (when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.
Patients with a history of diabetes [adjusted odds ratio (aOR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease (aOR = 3.98, 95%CI: 1.45-10.91), biliary tract infection (aOR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis (aOR = 2.19, 95%CI: 1.39-3.46), GI malignancies (aOR = 5.68, 95%CI: 4.23-7.64), appendicitis (aOR = 3.16, 95%CI: 2.27-4.41), diverticulitis (aOR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography (aOR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy (aOR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy (aOR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.
An upper GI panendoscopy performed before 90 d may increase the risk of PLA.
研究近期胃肠道（GI）内镜检查与随后发生化脓性肝脓肿（PLA）的风险之间的关系。
我们设计了一项巢式病例对照研究。使用台湾全民健康保险研究数据库，我们从 1998 年至 2011 年确定了 2135 例首次诊断为 PLA 的患者。另外选择了 10675 名年龄和性别相匹配无 PLA 的患者作为对照参考。我们确定并比较了两组中与 PLA 和 GI 内镜检查相关的可能危险因素，这些检查是在指数日期（当 PLA 被诊断时）之前进行的。多变量分析用于检查 GI 内镜检查后 90 天内 PLA 的风险。
患有糖尿病病史的患者[校正优势比（aOR）=4.92，95%置信区间（CI）：1.78-13.61]、终末期肾病（aOR=3.98，95%CI：1.45-10.91）、胆道感染（aOR=2.68，95%CI：2.11-3.40）、肝硬化（aOR=2.19，95%CI：1.39-3.46）、胃肠道恶性肿瘤（aOR=5.68，95%CI：4.23-7.64）、阑尾炎（aOR=3.16，95%CI：2.27-4.41）、憩室炎（aOR=1.64，95%CI：1.01-2.64）和近期内镜逆行胰胆管造影术（aOR=27.04，95%CI：11.65-62.72）与 PLA 风险增加显著相关。在调整了上述危险因素以及指数日期前 90 天内门诊就诊次数和腹部超声检查的频率后，上胃肠道全内镜检查（aOR=2.75，95%CI：2.05-3.69）而不是下胃肠道内镜检查（aOR=1.07，95%CI：0.62-1.86）与 PLA 显著相关。
90 天内进行上胃肠道全内镜检查可能会增加 PLA 的风险。
