Koga Yasutaka, Fujita Motoki, Nakahara Takashi, Yagi Takeshi, Miyauchi Takashi, Kaneda Kotaro, Kawamura Yoshikatsu, Oda Yasutaka, Tsuruta Ryosuke
Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan.
Acute and General Medicine Yamaguchi University Graduate School of Medicine Ube Yamaguchi Japan.
Acute Med Surg. 2016 May 3;3(4):339-344. doi: 10.1002/ams2.204. eCollection 2016 Oct.
A small spleen, which is occasionally found in patients with pneumococcal sepsis, may increase pneumococcal susceptibility because of splenic malfunction. However, a small spleen may also originate from severe disease. We carried out a retrospective study to evaluate the association between splenic volume and severe pneumococcal sepsis or disease severity.
We reviewed the medical records of 23 patients with severe pneumococcal sepsis treated at our institution between January 2004 and September 2015 (pneumococcal group) and 61 patients with severe non-pneumococcal bacteremia treated between April 2011 and September 2015 (control group). Splenic volume measured by abdominal computed tomography on admission was compared between the two groups. Correlations between Acute Physiology and Chronic Health Evaluation (APACHE) II scores and splenic volume on admission and the change in splenic volume from the non-septic state to admission were also determined.
Splenic volume on admission was significantly smaller ( = 0.001) and a small spleen was more frequent ( < 0.001) in the pneumococcal group. The APACHE II score was negatively correlated with splenic volume on admission ( = -0.46, < 0.001) and the change in splenic volume ( = -0.44, = 0.004). Pneumococcal infection (odds ratio 13.1, 95% confidence interval 2.6-65.7; = 0.002) and APACHE II score (odds ratio 1.2, 95% confidence interval 1.1-1.3; = 0.002) were independently associated with small spleen.
Splenic volume decreased with increasing severity of severe sepsis. A small spleen was also associated with severe pneumococcal infection.
肺炎球菌败血症患者偶尔会出现脾脏较小的情况，脾脏功能障碍可能会增加对肺炎球菌的易感性。然而，脾脏较小也可能源于严重疾病。我们进行了一项回顾性研究，以评估脾脏体积与严重肺炎球菌败血症或疾病严重程度之间的关联。
我们回顾了2004年1月至2015年9月在我院接受治疗的23例严重肺炎球菌败血症患者（肺炎球菌组）和2011年4月至2015年9月接受治疗的61例严重非肺炎球菌菌血症患者（对照组）的病历。比较两组入院时通过腹部计算机断层扫描测量的脾脏体积。还确定了急性生理与慢性健康状况评估（APACHE）II评分与入院时脾脏体积以及从非脓毒症状态到入院时脾脏体积变化之间的相关性。
肺炎球菌组入院时的脾脏体积明显较小（P = 0.001），脾脏较小的情况更为常见（P < 0.001）。APACHE II评分与入院时的脾脏体积呈负相关（r = -0.46，P < 0.001）以及脾脏体积变化（r = -0.44，P = 0.004）。肺炎球菌感染（优势比13.1，95%置信区间2.6 - 65.7；P = 0.002）和APACHE II评分（优势比1.2，95%置信区间1.1 - 1.3；P = 0.002）与脾脏较小独立相关。
严重脓毒症的严重程度增加时，脾脏体积减小。脾脏较小也与严重肺炎球菌感染有关。
