Yang C C, Chen C Y, Lin X Z, Chang T T, Shin J S, Lin C Y
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Am J Gastroenterol. 1993 Nov;88(11):1911-5.
Ninety-seven cases of pyogenic liver abscesses in a 4-yr period were studied: 27.8% (27 cases) were associated with biliary tract stone, 5.2% (five cases) were associated with biliary tract cancer, and there were two cases of diabetes (2.1%) associated with anal infection, but 63.9% (63 cases) were diagnosed as cryptogenic. Forty patients (64.5%) in the cryptogenic group had diabetes mellitus, and 23 of them (23/40, 57.5%) had gas-forming infection. All patients received parenteral antibiotics therapy, percutaneous aspiration, drainage, or operation. The overall mortality was 16.5%. Diabetes mellitus alone, without demonstrable infectious foci, was an important predisposing factor for pyogenic liver infection. Furthermore, to evaluate the clinical importance of gas-forming pyogenic liver infections, we separated these 42 diabetic patients into gas-forming and non-gas-forming groups, after sonography and CT scan. Klebsiella pneumoniae was the major pathogen in both groups. There was no significant difference in the clinical manifestations, complication, bacterial culture, or laboratory data between these two groups, except that the AST level was higher in the gas-forming group. However, the gas-forming group had higher mortality rate (30.4% vs. 5.3%). Gas-forming liver abscesses were common among the diabetics. Early and adequate drainage for pyogenic liver abscesses with parenteral antibiotics are crucial in their management.
对4年期间的97例化脓性肝脓肿病例进行了研究：27.8%（27例）与胆道结石有关，5.2%（5例）与胆道癌有关，有2例（2.1%）糖尿病与肛门感染有关，但63.9%（63例）被诊断为隐源性。隐源性组中有40例患者（64.5%）患有糖尿病，其中23例（23/40，57.5%）发生了产气感染。所有患者均接受了肠外抗生素治疗、经皮穿刺抽吸、引流或手术。总体死亡率为16.5%。单独的糖尿病，无明显感染灶，是化脓性肝感染的重要易感因素。此外，为了评估产气化脓性肝感染的临床重要性，我们在超声和CT扫描后将这42例糖尿病患者分为产气组和非产气组。肺炎克雷伯菌是两组中的主要病原体。除了产气组的AST水平较高外，两组在临床表现、并发症、细菌培养或实验室数据方面没有显著差异。然而，产气组的死亡率较高（30.4%对5.3%）。产气性肝脓肿在糖尿病患者中很常见。早期并充分引流化脓性肝脓肿并联合肠外抗生素治疗对其管理至关重要。
