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第41卷第12期 南京医科大学学报（自然科学版）
2021年12月 Journal of Nanjing Medical University（Natural Sciences） ·1791 ·

·临床医学·

肝脓肿致脓毒症的临床特征分析及早期诊断

袁 超，徐 杰，史阳阳，史薪伟，孙 凯 *
南京医科大学第一附属医院急诊医学中心，江苏 南京 210029

［摘 要］ 目的：分析肝脓肿继发脓毒症患者的临床特征，为早期诊断提供依据。方法：取南京医科大学第一附属医院2017年
1月—2021年4月期间诊治的237例肝脓肿患者为研究对象，分为无脓毒症组和继发脓毒症组，分析两组的临床特征。结果：
糖尿病患者更容易发生肝脓肿（72.6%）；依qSOFA 对继发脓毒症组患者行回顾性评估，其在呼吸频率≥22次/min（P <0.007）、
GCS评分<13分（P < 0.001）和收缩压≤100 mmHg（P < 0.001）方面较无脓毒症组差异有统计学意义；继发脓毒症组患者白细胞
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计数［（13.81±6.89）×10 个/L vs.（10.91±6.89）×10 个/L，P < 0.001］和中性粒细胞比值（84.29±8.15）% vs.（79.86±12.68）%，P=
0.021］明显升高，C反应蛋白（P=0.048）和降钙素原（P < 0.001）较无脓毒症组也升高，继发脓毒症组血糖控制较差（P=0.016）；
导致肝脓肿的首位细菌是肺炎克雷伯杆菌（76.8%）。结论：糖尿病患者易继发肝脓肿；qSOFA可用于肝脓肿病情严重程度的
早期判断；肺炎克雷伯杆菌是肝脓肿的主要致病菌；白细胞计数、中性粒细胞比值、C反应蛋白、降钙素原可用于早期诊断肝脓
肿。
［关键词］ 回顾性研究；肝脓肿；脓毒症；qSOFA；早期诊断
［中图分类号］ R575.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）12⁃1791⁃05
doi：10.7655/NYDXBNS20211213

Analysis of clinical features and early diagnosis of sepsis caused by liver abscess

YUAN Chao，XU Jie，SHI Yangyang，SHI Xinwei，SUN Kai *
Department of Emergency，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：This study aims to analyze the clinical features of patients with sepsis secondary to liver abscess and find the
early diagnostic indicators. Methods：A total of 237 patients with liver abscess diagnosed and treated in the First Affiliated Hospital of
Nanjing Medical University from January 2017 to April 2021 were selected as the research subjects. They were divided into two groups：
the non⁃sepsis group and the sepsis group，and the clinical characteristics of the two groups were analyzed. The data was analyzed using
SPSS 22.0. Results：Diabetic patients were more prone to liver abscess（72.6%）. Patients in the sepsis group were retrospectively
evaluated according to qSOFA. Compared with the non⁃sepsis group，the differences in respiratory rate ≥22 cpm（0.007），GCS<13（P <
0.001）and systolic blood pressure were statistically significant. The white blood cell count of patients with sepsis group［（13.81±6.89）×
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10 /L vs.（10.91±6.89）×10 /L，P < 0.001］，the neutrophil ratio［（84.29±8.15）% vs.（79.86±12.68）%，P=0.021］，C⁃reactive protein
（P=0.048）and procalcitonin（P < 0.001）were higher than those in the non⁃sepsis group. Blood glucose control was worse in the sepsis
group（P=0.016）. There was no difference in abscess growth location and bacteriological culture between the two groups. The leading
cause of liver abscess was Klebsiella pneumoniae（76.8%）. Conclusion：Diabetic patients are prone to secondary liver abscess. The
qSOFA can be used for the early judgment of the severity of liverabscess. WBC count，neutrophil ratio，C ⁃ reactive protein and
procalcitonin can be used for early diagnosis of liver abscess and further prediction of disease development. Klebsiella pneumoniae is
the main pathogen of liver abscess.
［Key words］ retrospective studies；liver abscess；sepsis；qSOFA；early diagnosis
［J Nanjing Med Univ，2021，41（12）：1791⁃1795］

［基金项目］ 国家自然科学基金（81871544）；江苏省科技厅基础研究计划（BK20181493）
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通信作者（Corresponding author），E⁃mail：sunkai@njmu.edu.cn