中国全科医学 ›› 2023, Vol. 26 ›› Issue (17): 2120-2124.DOI: 10.12114/j.issn.1007-9572.2022.0742

• 论著 • 上一篇    下一篇

细菌性肝脓肿患者发生血小板减少影响因素研究

马勇, 高伟波, 朱继红*()   

  1. 100044 北京市,北京大学人民医院急诊科
  • 收稿日期:2022-09-20 修回日期:2022-11-19 出版日期:2023-06-15 发布日期:2022-12-02
  • 通讯作者: 朱继红

  • 作者贡献:马勇负责收集资料,撰写论文;高伟波负责数据的统计及论文的修改;朱继红负责课题设计,文章的审查和修订,并最后定稿,对文章整体负责。

Risk Factors of Thrombocytopenia Caused by Pyogenic Liver Abscess

MA Yong, GAO Weibo, ZHU Jihong*()   

  1. Department of Emergency Medicine, Peking University People's Hospital, Beijing 100044, China
  • Received:2022-09-20 Revised:2022-11-19 Published:2023-06-15 Online:2022-12-02
  • Contact: ZHU Jihong

摘要: 背景 细菌性肝脓肿(PLA)是临床常见的内脏器官感染性疾病,既往PLA发生血小板减少的临床研究较少。 目的 分析PLA患者发生血小板减少的流行病学和临床特征,并探讨发生血小板减少的影响因素。 方法 纳入北京大学人民医院2011年1月至2020年12月161例因PLA住院的患者为研究对象。收集患者资料,包括年龄、性别、体质指数(BMI)、发病症状(发热、腹痛、恶心、呕吐)、既往病史信息(高血压、糖尿病、冠心病、肝胆疾病、恶性肿瘤);收集患者入院时辅助检查结果,包括白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值(ALC)、单核细胞绝对值、血红蛋白、C反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、尿素氮(BUN)、肌酐(Scr)、白蛋白(ALB)、凝血酶原时间(PT)、活化部分凝血活酶时间、纤维蛋白原、D-二聚体(D-Dimer)、血小板计数(PLT);收集患者肝脓肿影像学检查(腹部CT或超声)结果(是否多个脓肿)、病原学检查结果(血培养、培养出肺炎克雷伯菌比例);收集患者的并发症情况及预后情况。根据外周血PLT是否<100×109/L将患者分为发生PLT减少组(n=21)和未发生PLT减少组(n=140),比较两组患者资料,并采用多因素Logistic回归分析探究PLA患者发生血小板减少的影响因素。 结果 发生PLT减少组患者BMI高于未发生PLT减少组(P<0.05);发生PLT减少组患者ALC、ALB、PT低于未发生PLT减少组,CRP、PCT、ALT、AST、TBiL、BUN、Scr、D-Dimer高于未发生PLT减少组(P<0.05);发生PLT减少组患者并发肺炎、并发脑脓肿、入住ICU所占比例高于未发生PLT减少组(P<0.05)。ALB〔OR=0.255,95%CI(0.074,0.877)〕、PT〔OR=0.282,95%CI(0.085,0.941)〕是PLA患者发生血小板减少的影响因素(P<0.05)。 结论 ALB、PT是PLA患者发生血小板减少的影响因素。PLA患者应密切监测PLT水平,尤其是合并ALB降低及PT缩短者。

关键词: 肝脓肿,化脓性, 血小板减少, 细菌感染, 预后, 危险因素, Logistic模型, 感染性疾病

Abstract:

Background

Pyogenic liver abscess (PLA) is a common visceral infectious disease, its associated thrombocytopenia has been rarely studied clinically.

Objective

To discuss the epidemiological and clinical characteristics as well as risk factors of thrombocytopenia secondary to PLA.

Methods

All 161 patients hospitalized for PLA in Peking University People's Hospital from January 2011 to December 2020 were recruited. Patient data were collected, including general demographics〔age, gender, body mass index (BMI) , symptoms (fever, abdominal pain, nausea, vomiting) , and past medical history information (hypertension, diabetes, coronary heart disease, hepatobiliary disease, and cancer) , auxiliary examination results, including white blood cell count, absolute neutrophil count, absolute lymphocyte count (ALC) , absolute monocyte count, hemoglobin, C-reactive protein (CRP) , procalcitonin (PCT) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBiL) , blood urea nitrogen (BUN) , serum creatinine (Scr) , albumin (ALB) , prothrombin time (PT) , activated partial thromboplastin time, fibrinogen, D-Dimer, platelet count (PLT) 〕, imaging examination results (abdominal CT or ultrasonographic findings of liver abscesses) , pathogenic examination results (blood culture, prevalence of cultured Klebsiella pneumoniae) and complications and prognosis. The above-mentioned data were compared between group with decreased PLT (n=21) and group without decreased PLT (n=140) divided by the prevalence of PLT less than 100×109/L. The risk factors of thrombocytopenia were analyzed by multivariate Logistic regression analysis.

Results

The mean BMI in PLT reduction group was statistically significant higher than that in non-PLT reduction group (P<0.05) . PLT reduction group had much lower mean levels of ALC and ALB, PT, and much higher mean levels of CRP, PCT, ALT, AST, TBiL, BUN, Scr and D-Dimer than non-PLT reduction group (P<0.05) . Furthermore, PLT reduction group had significantly higher prevalence of concomitant pneumonia, brain abscess and ICU admission (P<0.05) . ALB〔OR=0.255, 95%CI (0.074, 0.877) 〕and PT〔OR=0.282, 95%CI (0.085, 0.941) 〕were influencing factors for thrombocytopenia in PLA (P<0.05) .

Conclusion

ALB and PT are the influencing factors of thrombocytopenia in PLA patients. PLT levels should be closely monitored in PLA patients, especially those with reduced ALB and decreased PT.

Key words: Liver abscess, pyogenic, Thrombocytopenia, Bacterial infection, Prognosis, Risk factors, Logistic model, Infectious disease