2型糖尿病并发侵袭性肺炎克雷伯菌肝脓肿综合征1例报告及文献复习

朱新琳; 张琳; 曾正艳; 吴亚楠; 李灿晖

doi:10.16766/j.cnki.issn.1674-4152.003272

2型糖尿病并发侵袭性肺炎克雷伯菌肝脓肿综合征1例报告及文献复习

doi: 10.16766/j.cnki.issn.1674-4152.003272

昆明医科大学第一附属医院全科医学科，云南昆明 650000

基金项目:

云南省卫生科技计划项目 2017NS019

详细信息

通讯作者:
李灿晖, E-mail: 11439914@qq.com

中图分类号: R587.1R517.6
计量
- 文章访问数: 162
- HTML全文浏览量: 61
- PDF下载量: 22
- 被引次数: 0
出版历程
- 收稿日期: 2022-10-24
- 网络出版日期: 2024-01-13

Invasive Klebsiella pneumoniae liver abscess syndrome in type 2 diabetes mellitus: a case report and literature review

Department of General Practice, the First Hospital of Kunming Medical University, Yunnan, Kunming 650000, China

摘要

摘要: 近年来2型糖尿病并发侵袭性肺炎克雷伯菌肝脓肿综合征(invasive Klebsiella pneumoniae liver abscess syndrome，IKLAS)逐渐进入大众视野，基于其症状隐匿、高毒力性和易发转移性感染的特征，使临床上在应对该类病例时尤为棘手。本文通过报道并回顾性分析1例2型糖尿病并发侵袭性肺炎克雷伯菌肝脓肿综合征患者的诊断、治疗及预后，复习相关文献，力求增加医务人员对IKLAS的认识和了解，使其能早诊断早治疗，改善临床诊疗效果。
- 糖尿病 /
- 肝脓肿 /
- 肺炎克雷伯菌 /
- 侵袭 /
- 病例报告
Abstract: In recent years, invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) has gradually developed in type 2 diabetes mellitus (T2DM). Due to its hidden symptoms, high virulence and susceptibility to metastatic infection, it is particularly difficult to manage such cases in the clinic. The diagnosis, treatment and prognosis of a case of T2DM complicated with invasive Klebsiella pneumoniae liver abscess syndrome were reported and retrospectively analyzed, and the relevant literature was reviewed, in order to improve the knowledge and understanding of IKLAS for medical personnel so that they can achieve early diagnosis and treatment. Improve the clinical treatment effect.
- Diabetes /
- Liver abscess /
- Klebsiella pneumoniae /
- Invasion /
- Case report

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图 1 2021年11月11日急诊胸部CT

注：胸部CT示双肺上叶散在结节(9~25 mm)。

Figure 1. Emergency chest CT on November 11, 2021

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图 2 2021年11月18日腹部MRI平扫+增强

腹部MRI平扫+增强示肝s8异常信号肿块(5.7 cm×8.0 cm)。

Figure 2. Abdominal MRI plain scan + enhancement on November 18, 2021

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图 3 2021年11月24日胸部CT平扫+增强

注：腹部CT平扫+增强示肝s8见片状低密度影(8.6 cm×6.4 cm)。

Figure 3. Chest CT plain scan+enhanced scan on November 24, 2021

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图 4 2021年11月24日腹部CT平扫+增强

Figure 4. Abdominal CT plain scan+enhanced scan on November 24, 2021

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图 5 2021年11月29日胸部CT

Chest CT on November 29, 2021

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图 6 2021年11月29日腹部CT

注：腹部CT示肝s8见片状低密度影(3.2 cm×6.4 cm)。

Figure 6. Abdominal CT on November 29, 2021

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图 7 2022年1月11日胸部CT

Figure 7. Chest CT on January 11, 2022

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图 8 2022年1月11日腹部CT

注：腹部CT示肝s8病变(2.0 cm×2.2 cm)。

Figure 8. Abdominal CT on January 11, 2022

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参考文献(20)

[1]	刘献清, 凌保东, 赖巧, 等. 高毒力肺炎克雷伯杆菌相关研究及相关肝脓肿治疗策略[J]. 国外医药(抗生素分册), 2020, 41(6): 454-458. doi: 10.3969/j.issn.1001-8751.2020.06.008 LIU X Q, LING B D, LAI Q, et al. Study on Klebsiella pneumoniae with high virulence and treatment strategy of liver abscess[J]. World Notes on Antibiotics, 2020, 41(6): 454-458. doi: 10.3969/j.issn.1001-8751.2020.06.008
[2]	WANG W J, TAO Z, WU H L. Etiology and clinical manifestations of bacterial liver abscess: a study of 102 cases[J]. Medicine, 2018, 97(38): e12326. DOI: 10.1097/MD.0000000000012326.
[3]	尹大龙, 刘连新. 细菌性肝脓肿诊治进展[J]. 中国实用外科杂志, 2013, 33(9): 793-795. YIN D L, LIU L X. Progress in diagnosis and treatment of bacterial liver abscess[J]. Chinese Journal of Practical Surgery, 2013, 33(9): 793-795.
[4]	王斐, 陈开宁, 全会标. 64例2型糖尿病合并肺炎克雷伯菌肝脓肿患者的临床表现、病原菌药物敏感性及治疗分析[J]. 山东医药, 2021, 61(33): 88-91. doi: 10.3969/j.issn.1002-266X.2021.33.022 WANG F, CHEN K N, QUAN H B. Clinical manifestations, drug sensitivity and treatment of pathogenic bacteria in 64 patients with type 2 diabetes mellitus complicated with Klebsiella pneumoniae liver abscess[J]. Shandong Medical Journal, 2021, 61(33): 88-91. doi: 10.3969/j.issn.1002-266X.2021.33.022
[5]	于丽侠, 刘杨, 黄海辉, 等. 肺炎克雷伯菌感染所致肝脓肿侵袭综合征病例分析并文献复习[J]. 复旦学报(医学版), 2019, 46(1): 64-69. doi: 10.3969/j.issn.1672-8467.2019.01.011 YU L X, LIU Y, HUANG H H, et al. Case analysis and literature review of hepatic abscess invasion syndrome caused by Klebsiella pneumoniae infection[J]. Fudan University Journal of Medical Sciences, 2019, 46(1): 64-69. doi: 10.3969/j.issn.1672-8467.2019.01.011
[6]	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. doi: 10.3969/j.issn.1001-5256.2018.07.046 ZHANG S Y, CHEN Y X. Progress in diagnosis and treatment of bacterial liver abscess[J]. Journal of Clinical Hepatology, 2018, 34(7): 1577-1580. doi: 10.3969/j.issn.1001-5256.2018.07.046
[7]	黄洋, 张伟辉. 细菌性肝脓肿的诊治进展[J]. 临床肝胆病杂志, 2018, 34(3): 641-644. doi: 10.3969/j.issn.1001-5256.2018.03.045 HUANG Y, ZHANG W H. Progress in diagnosis and treatment of bacterial liver abscess[J]. Journal of Clinical Hepatology, 2018, 34(3): 641-644. doi: 10.3969/j.issn.1001-5256.2018.03.045
[8]	汪强, 葛玉梅, 刘建芳, 等. 肝脓肿高毒力肺炎克雷伯菌耐药性及毒力基因型流行性分析[J]. 中华医院感染学杂志, 2016, 26(24): 5531-5533, 5586. WANG Q, GE Y M, LIU J F, et al. Analysis of drug resistance and virulence genotypes of high virulence Klebsiella pneumoniae in liver abscess[J]. Chinese Journal of Nosocomiology, 2016, 26(24): 5531-5533, 5586.
[9]	XU S, WANG Y, CHEN J, et al. Application of ultrasound-guided percutaneous intrahepatic portal vein catheterization with antibiotic injection for treating unliquefied bacterial liver abscess[J]. Hepatol Res, 2017, 47(3): E187-E192.
[10]	WELLS J T, LEWIS C R, DANNER O K, et al. Klebsiella pneumoniae liver abscess and metastatic endophthalmitis[J]. J Investig Med High Impact Case Rep, 2016, 4(1): 2324709615624125.
[11]	EVANGELISTA V, GONÇALVES C V, ALMEIDA R, et al. Klebsiella pneumoniae invasive syndrome[J]. Eur J Case Rep Intern Med, 2018, 5(3): 000800.
[12]	PREMATHILAKE P N S, KULARATNE W K S, JAYATHILAKE J P K, et al. Klebsiella pneumoniae liver abscess: a case report[J]. J Med Case Rep, 2018, 12(1): 367. doi: 10.1186/s13256-018-1924-4
[13]	刘兆玉, 畅智慧, 王海瑞, 等. 肝脓肿介入治疗辽宁专家共识(2022)[J]. 介入放射学杂志, 2022, 31(7): 642-650. doi: 10.3969/j.issn.1008-794X.2022.07.002 LIU Z Y, CHANG Z H, WANG H R, et al. Expert consensus on interventional treatment of liver abscess in Liaoning[J]. Journal of Interventional Radiology, 2022, 31(7): 642-650. doi: 10.3969/j.issn.1008-794X.2022.07.002
[14]	JAMSHAID M B, SHAHZAD A, ZAFAR A, et al. Invasive Klebsiella pneumoniae syndrome in Qatar: a case report[J]. Cureus, 2021, 13(5): e15015. DOI: 10.7759/cureus.15015.
[15]	WANG F, YU J, CHEN W, et al. Clinical characteristics of diabetes complicated by bacterial liver abscess and nondiabetes-associated liver abscess[J]. Dis markers, 2022, 2022: 7512736. DOI: 10.1155/2022/7512736.
[16]	LIN Y T, WANG F D, WU P F, et al. Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics[J]. BMC Infect Dis, 2013, 13: 56. doi: 10.1186/1471-2334-13-56
[17]	WANG H H, TSAI S H, YU C Y, et al. The association of haemoglobin AıC levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus[J]. Eur radiol, 2014, 24(5): 980-989. doi: 10.1007/s00330-014-3113-1
[18]	张健, 沈振华, 吴小昌. 不同血糖控制水平的化脓性肝脓肿患者临床特点和预后分析[J]. 浙江临床医学, 2022, 24(3): 361-363. ZHANG J, SHEN Z H, WU X C. Analysis of clinical characteristics and prognosis of patients with suppurative liver abscess with different blood glucose control levels[J]. Zhejiang clinical medicine, 2022, 24(3): 361-363.
[19]	徐绮, 薛锦花, 刘连勇, 等. 某社区中年人群糖尿病患者综合管理现况与分析[J]. 中华全科医学, 2017, 15(8): 1374-1377. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.030 XU Q, XUE J H, LIU L Y, et al. Current situation and analysis of comprehensive management of middle-aged diabetic patients in a community[J]. Chinese Journal of General Practice, 2017, 15(8): 1374-1377. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.030
[20]	王娴, 潘研, 巴明玉, 等. 2型糖尿病患者膳食因素与平均血糖波动幅度的关联性研究[J]. 中华全科医学, 2022, 20(10): 1691-1694, 1796. doi: 10.16766/j.cnki.issn.1674-4152.002681 WANG X, PAN Y, BA M Y, et al. Correlation between dietary factors and mean blood glucose fluctuation in type 2 diabetes mellitus[J]. Chinese Journal of General Practice, 2022, 20(10): 1691-1694, 1796. doi: 10.16766/j.cnki.issn.1674-4152.002681