摘要
目的总结分析艾滋病合并肝脓肿患者的临床表现、诊断、治疗和预后,为临床诊治提供参考。方法收集上海市公共卫生临床中心2015年1月至2020年12月收治的艾滋病合并肝脓肿患者的临床资料,回顾性分析其临床特征、治疗情况及预后等。结果41例患者均确诊艾滋病合并肝脓肿,男40例,女1例,其中经治艾滋病肝脓肿患者17例,年龄(39.2±11.6)岁,未治疗艾滋病肝脓肿患者24例,年龄(35.7±9.5)岁。主要表现为发热(85.4%)和肝区不适(34.1%)。41例患者均出现CRP升高,CD4降低34例(82.9%),中性粒细胞百分比升高27例(65.9%),GGT升高35例(85.4%),ALB降低39例(95.1%)。肝脓肿病灶主要位于肝右叶26例(63.4%),肝左叶7例(17.1%),双叶8例(19.5%),多发脓肿13例(31.7%)。治疗上以联合抗感染为主,32例(78.0%)患者联合穿刺引流,40例(97.6%)患者痊愈或好转出院。结论艾滋病合并肝脓肿患者临床特征无特异性,病情复杂多变。早期经验性治疗推荐碳青霉烯类或第三代头孢菌素联合硝基咪唑类抗生素,注意特殊病原体感染。脓肿穿刺引流安全有效,未治疗艾滋病肝脓肿患者建议尽早HAART治疗,可减少机会菌感染,可能减少肝脓肿复发。
Objective To summarize and analyze the clinical manifestations,diagnosis,treatment and prognosis of acquired immune deficiency syndrome patients with liver abscess in order to provide reference for clinical diagnosis and treatment.Methods The clinical data of acquired immune deficiency syndrome patients with liver abscess admitted to Shanghai Public Health Clinical Center from Jan.2015 to Dec.2020 were collected,and their clinical features,treatment and prognosis were analyzed retrospectively.Results All the 41 patients were diagnosed as acquired immune deficiency syndrome complicated with liver abscess,including 40 males and 1 female,including 17 patients with treated acquired immune deficiency syndrome liver abscess,with the age of(39.2±11.6)years old,and 24 patients with untreated acquired immune deficiency syndrome liver abscess,with the age of(35.7±9.5)years old.The main manifestations were fever(85.4%)and liver discomfort(34.1%).In all 41 patients,CRP increased,CD4 decreased in 34 cases(82.9%),neutrophil percentage increased in 27 cases(65.9%),GGT increased in 35 cases(85.4%),ALB decreased in 39 cases(95.1%).The focus of liver abscess was mainly located in right lobe in 26 cases(63.4%),left lobe in 7 cases(17.1%),double lobe in 8 cases(19.5%),and multiple abscess in 13 cases(31.7%).The treatment was mainly combined with anti-infection,32 patients(78.0%)were treated with puncture and drainage,and 40 patients(97.6%)were cured or discharged from the hospital.Conclusion The clinical characteristics of acquired immune deficiency syndrome patients with liver abscess are not specific,and the condition is complex and changeable.Early empirical treatment recommends carbapenem or the third generation cephalosporins combined with nitroimidazole antibiotics and pay attention to special pathogen infection.Abscess puncture and drainage is safe and effective.HAART treatment is recommended for patients with untreated acquired immune deficiency syndrome liver abscess as soon as possible,which can reduce opportunistic bacterial infection and may reduce the recurrence of liver abscess.
作者
李俊
樊贞瑜
张亚军
田成
杨敬貌
陈丽萍
刘晓菲
程计林
LI Jun;FAN Zhenyu;ZHANG Yajun;TIAN Cheng;YANG Jingmao;CHEN Liping;LIU Xiaofei;CHENG Jilin(Department of Gastroenterology and Hepatology,Shanghai Public Health Clinical Center,Shanghai 201508,China)
出处
《胃肠病学和肝病学杂志》
CAS
2022年第5期527-531,共5页
Chinese Journal of Gastroenterology and Hepatology
基金
上海市科学技术委员会引导基金(17411969500)
上海市公共卫生临床中心科研启动基金(KW-GW-2017-22)。
关键词
艾滋病
肝脓肿
诊断
治疗
Acquired immune deficiency syndrome
Liver abscess
Diagnosis
Treatment
作者简介
第一作者:李俊,主治医师,研究方向:肝脏相关疾病的诊断及治疗。E-mail:lijun@shphc.org.cn;通讯作者:程计林,博士生导师,主任医师,研究方向:干细胞在肝脏疾病的分化及调控机制。E-mail:chengjilin@shphc.org.cn。
