Pyogenic Liver Abscess-Comparison between Diabetic Patients and Non-Diabetic Patients

化膿性肝膿瘍：比較糖尿病患者及非糖尿病患者間的差異

郭明正(Ming-Jeng Kuo) ； 牟聯瑞(Lein-Ray Mo) ； 周建玲(Chien-Lin Chou) ； 張國寬(Kuo-Kwan Chang) ； 王俊雄(Chun-Hsiang Wang) ； 林瑞昌(Ruey-Chang Lin) ； 郭振源(Jen-Juan Kuo) ； 魏克承(Keh-Cherng Wey)

《臺灣消化醫學雜誌》 27卷4期 (2010/12) Pp. 403-409

https://doi.org/10.6557/GJT.201012_27(4).0002

摘要

研究動機：化膿性肝膿瘍是少見、致命的疾病，而糖尿病是最常見的危險因子。本研究的主要目地是比較糖尿病及非糖尿患者的化膿性肝膿瘍在臨床表現特性上有何不同。另外，也將探討化膿性肝膿瘍患者死亡的預測因子。
材料及方法：我們對2003年1月至2009年5月間住院的120位化膿性肝膿瘍患者進行回溯性研究。依據糖尿病的有無將其分爲兩組，並以二分變項的統計方法去分析兩組臨床表徵的不同。此外，我們也利用多變項logistic迴歸模型的分析方法來找出可能造成化膿性肝膿瘍患者死亡的預測因子。
結果：在120位的化膿性肝膿瘍患者中，有糖尿病的患者占了60位。分析比較兩組的結果發現，糖尿病的化膿性肝膿瘍患者有較高比例的細菌培養結果爲K pneumonia (P=0.003)及合併有高血壓(P=0.0007)；非糖尿病的化膿性肝膿瘍患者有較高的比例合併膽道結石(P=0.036)、過去接受肝或膽道醫療處置的病史(P=0.049)、偏高的鹼性磷酸酶(P=0.034)以及較多患者接受膿瘍引流(P=0.05)。糖尿病並非是化膿性肝膿瘍患者死亡的預測因子。血清肌肝酸大於1.5 g/dl (adjusted OR 5.4, 95% CI 1.4-20.8)及血清白蛋白小於3.0 g/dl(adjusted OR 11.6, 95% CI 1.4-98.3)是造成化膿性肝膿瘍患者死亡的獨立預測因子。
結論：在糖尿病及非糖尿病的化膿性肝膿瘍患者有許多不同的臨床表現，而腎功能不全及低白蛋白血症是造成化膿性肝膿瘍患者不良預後的預測因子。

關鍵字

化膿性肝膿瘍 ； 糖尿病 ； 預測因子

並列摘要

Background and Aims: Pyogenic liver abscess (PLA) is a rare and life threatening disease. Diabetes is also known as the most common risk factor for PLA. The objective of this study is to compare the nature of PLA between patients with diabetes and without. We also tried to identify if diabetes was an independent predictor for mortality in patients with PLA.
Methods: We conducted a retrospective study of 120 patients who presented with PLA from January 2003 to May 2009. Patients were divided into two groups depending on whether they had diabetes or not. Characteristics of these patients were analyzed by two-sample test for interval and categorical data. Significant predictors of mortality in patients with PLA were investigated by multivariate logistic regression.
Results: Fifty percent of the 120 studied PLA patients were found with diabetes mellitus. Those PLA patients with diabetes were more likely to have a culture result of Klebsiella pneumonia and hypertension. In contrast, more PLA patients without diabetes had concomitant biliary stones, a history of hepatobiliary procedures, and elevated alkaline phosphatase level. These patients also received more treatment of catheter drainage. Diabetes was not an independent predictor for mortality in PLA. Impaired renal function with creatinine＞1.5 g/dl (adjusted OR 5.4, 95% CI 1.4-20.8) and hypoalbuminemia with albumin＜3.0 g/dl (adjusted OR 11.6, 95% CI 1.4-98.3) were independent predictors for mortality in PLA.
Conclusion: There were several different characteristics between diabetic and non-diabetic PLA. Initial presentations with renal insufficiency and hypoalbuminemia were associated with poor prognosis in patients with PLA.

並列關鍵字

pyogenic liver abscess ； diabetes ； predictor