肝脓肿76例临床特点及初期中医舌象、脉象观察
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摘要
目的通过回顾性研究,探讨肝脓肿患者的临床症状、体征、病原学分布、辅助检查的特点,以及中医舌象、脉象表现,以提高诊治水平。方法回顾性分析2007年1月至2017年12月北京友谊医院感染内科收治的76例肝脓肿患者的临床资料,包括临床症状、体征、辅助检查、中医舌质、舌苔、脉象特点。结果在本研究中男性患者55例,28例患者合并糖尿病,23例患者合并胆囊炎;72例患者临床表现以发热为主,右上腹痛33例;致病菌以肺炎克雷白菌为主(包括血培养及脓液培养阳性),占全部病例的57.89%;初期舌质红:红绛舌43.42%,淡红舌31.58%;舌苔偏黄燥:黄苔44.74%、苔燥19.74%;脉象弦数:其中以数脉(52.63%)最为常见,其次为弦脉43.42%,滑脉39.47%。治疗以全身应用抗菌药物结合超声引导下肝脓肿穿刺作为肝脓肿首选治疗方法。治疗有效率为98.68%。结论在收集的76例患者中肝脓肿以男性多发,病原学以肺炎克雷白菌最常见,症状主要为发热、右上腹痛等,糖尿病是发病的主要危险因素。发病初期中医舌象脉象方面,舌质以红绛舌及淡红舌为常见、舌苔以黄苔、苔燥为常见、脉象以数,弦、滑为常见。
Objective: To explore the clinical symptoms,signs,pathogenic distribution,characteristics of auxiliary examinations,tongue and pulse manifestations of liver abscess in order to improve the level of diagnosis and treatment through retrospective study. Methods: The clinical data of 76 patients with liver abscess admitted to the Infection Department of Beijing Friendship Hospital from January 2007 to December 2017 were retrospectively analyzed,including clinical symptoms,signs,auxiliary examinations,tongue texture,tongue coating and pulse characteristics. Results: In this study,there were 55 male patients,28 patients with diabetes mellitus and 23 patients with cholecystitis. The main clinical manifestations of 72 patients were fever and 33 patients had right upper abdominal pain. Klebsiella pneumoniae(including positive blood culture and pus culture) accounted for 57.89%.Initial red tongue: red tongue 43.42%,light red tongue 31.58%. The tongue coating was yellowish and dry:44.74% and 19.74% respectively. The number of pulse strings: the number of pulse(52.63%) was the most common,followed by the number of pulse strings(43.42%) and the number of slippery pulse(39.47%). In the treatment of liver abscess,systemic antibiotics combined with ultrasound-guided puncture of liver abscess was the preferred treatment. The effective rate was 98.68%. Conclusions: Among the 76 patients collected,liver abscess is more common in males. Klebsiella pneumoniae is the most common pathogen. The main symptoms are fever and right upper abdominal pain. Diabetes mellitus is the main risk factor. In the early stage of onset,red and reddish tongues are common in tongue texture;yellow fur and dry fur are common in tongue coating;pulse counts are common in tongue texture,strings and slippery were common in tongue coating.
Objective: To explore the clinical symptoms,signs,pathogenic distribution,characteristics of auxiliary examinations,tongue and pulse manifestations of liver abscess in order to improve the level of diagnosis and treatment through retrospective study. Methods: The clinical data of 76 patients with liver abscess admitted to the Infection Department of Beijing Friendship Hospital from January 2007 to December 2017 were retrospectively analyzed,including clinical symptoms,signs,auxiliary examinations,tongue texture,tongue coating and pulse characteristics. Results: In this study,there were 55 male patients,28 patients with diabetes mellitus and 23 patients with cholecystitis. The main clinical manifestations of 72 patients were fever and 33 patients had right upper abdominal pain. Klebsiella pneumoniae(including positive blood culture and pus culture) accounted for 57.89%.Initial red tongue: red tongue 43.42%,light red tongue 31.58%. The tongue coating was yellowish and dry:44.74% and 19.74% respectively. The number of pulse strings: the number of pulse(52.63%) was the most common,followed by the number of pulse strings(43.42%) and the number of slippery pulse(39.47%). In the treatment of liver abscess,systemic antibiotics combined with ultrasound-guided puncture of liver abscess was the preferred treatment. The effective rate was 98.68%. Conclusions: Among the 76 patients collected,liver abscess is more common in males. Klebsiella pneumoniae is the most common pathogen. The main symptoms are fever and right upper abdominal pain. Diabetes mellitus is the main risk factor. In the early stage of onset,red and reddish tongues are common in tongue texture;yellow fur and dry fur are common in tongue coating;pulse counts are common in tongue texture,strings and slippery were common in tongue coating.
引文
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[17]杨香生.肝脓肿中医辨治规律初探[J].江西医学院学报,2002,42(6):190-191.
[18]武志熊.小柴胡汤治疗肝脓肿的临床疗效观察[J].光明中医,2017,32(2):237-239.
[19]雷飞飞,谭华炳,李芳,等.清热化脓汤联合西药治疗肝脓肿疗效观察[J].湖北中医学学报,2010,8(4):49-50.
[20]毕保洪,李伟,李华.中西医结合治疗细菌性肝脓肿临床观察[J].中国中医急症,2015,24(1):157-159.
[21]盛天娇,林一帆,王长洪,等.中西医结合治疗肝脓肿有效性Meta分析[J].中国中西医结合消化杂志,21(12):638-641.
[2]Pang TC,Fung T,Samra J,et al.Pyogenic liver abscess:an audit of 10 years′experience[J].World J Gastroenterol,2011,17(12):1622-1630.
[3]章顺轶,陈岳祥.细菌性肝脓肿诊治进展[J].临床肝胆病杂志,2018,34(7):1577-1580.
[4]Meddings L,Myers RP,Hubbard J,et al.A population-based study of pyogenic liver abscesses in the United States:incidence,mortality,and temporal trends[J].Am J Gastroenterol,2010,105(1):117-124.
[5]Kim JK,Chung DR,Wie SH,et al.Risk factor analysis of invasiveliver abscess caused by the K1 serotype Klebsiellapneumoniae[J].Eur J ClinMicrobiol Infect Dis,2009,28:109-111.
[6]Meddings L,Myers RP,Hubbard J,et al.A population-based study of pyogenic liver abscesses in the United States:incidence,mortality,and temporal trends[J].Am J Gastroenterol,2010,105(1):117-124.
[7]Ahmad HAli,Roger D Smalligan,Mashrafi Ahmed,et al.Pyogenic liver abscess and the emergence of Klebsiellaas an etiology:a retrospective study[J].International Journal of General Medicine,2014,7:37-42.
[8]Ahmad HAli,Roger D Smalligan,Mashra fi Ahmed.Faisal AKhasawneh Pyogenic liver abscess and the emergenceofKlebsiella as an etiology:a retrospective studyInternational[J].Journal of General Medicine,2014,7:37-42.
[9]Rahimian J,Wilson T,Oram V,et al.Pyogenic liver abscess:recent trends in etiology and mortality[J].Clin Infect Dis,2004,39(11):1654-1659.
[10]Lederman ER,Crum NF.Pyogenic Liver abscess with a focus on klebsiella pneumoniae as a primary pathogen:an emerging disease with unique clinical characteristics[J].The American Journal of Gastroenterology,2005,100(2):322-331.
[11]Klebsiellapneumoniae as a primary pathogen:an emerging disease with unique clinical characteristics[J].Am J Gastroenterol,2005,100(2):322-331.
[12]Fedeles SV,Gallagher AR,Somlo S.Polycystin-1:a master regulator of intersecting cystic pathways[J].Trends Mol Med,2014,20(5):251-260.
[13]Gainullin VG,Hopp K,Ward CJ,et al.Polycystin-1 maturation requires polycystin-2 in a dose-dependent manner[J].JClin In-vest,2015,125(2):607-620.
[14]周波,王建华,颜志平.肝癌介入治疗后发生肝脓肿的危险因素分析[J].中国临床医学,2010,17(6):51-53.
[15]Lee Goldman,Dennis Ausiello.Cecil Textbook of medicine[M].22版.Elsevier Science Health Science Division,2009:1970-1980.
[16]Chung DR,Lee SS,Lee HR,et al.Korean Study Group for Liver Abscess.Emerging invasive liver abscess caused by K1serotype Klebsiellapneumoniae in Korea[J].J Infect,2007,54(6):578-583.
[17]杨香生.肝脓肿中医辨治规律初探[J].江西医学院学报,2002,42(6):190-191.
[18]武志熊.小柴胡汤治疗肝脓肿的临床疗效观察[J].光明中医,2017,32(2):237-239.
[19]雷飞飞,谭华炳,李芳,等.清热化脓汤联合西药治疗肝脓肿疗效观察[J].湖北中医学学报,2010,8(4):49-50.
[20]毕保洪,李伟,李华.中西医结合治疗细菌性肝脓肿临床观察[J].中国中医急症,2015,24(1):157-159.
[21]盛天娇,林一帆,王长洪,等.中西医结合治疗肝脓肿有效性Meta分析[J].中国中西医结合消化杂志,21(12):638-641.