Evaluation on efficacy and safety of precise treatment guided by ultrasound for acquired immune deficiency syndrome patients with liver abscess

doi:10.3877/cma.j.issn.1674-1358.2017.03.015

Abstract

Abstract:

Objective

To investigate the efficacy and safety of precise treatment guided by ultrasound for acquired immunodeficiency syndrome (AIDS) patients with liver abscess.

Methods

Total of 44 AIDS patients with liver abscesses (58 lesions) from January 2009 to April 2016 in our hospital were taken as the research objects, who were divided into percutaneous aspiration (PA) group and percutaneous catheter drainage (PCD) group according the size. The periods of body temperature returned to normal, closure of abscess, cure rate of a puncture, total cure rate and complications were compared between the two groups, respectively.

Results

There were 44 abscesses treated with PCD and 14 abscesses were treated with PA. The closure period of abscess in PCD group was significantly longer than that in PA group [(18.18 ± 8.73) d vs. (9.14 ± 3.96) d; t = 5.353, P < 0.001)]. The cure rate of a puncture in PCD group was significantly higher than that in PA group (44/44 vs. 8/14, P < 0.001). Complications (0/44 vs. 1/14, P = 0.241) and period of body temperature returned to normal [(1.60 ± 0.52) d vs. (1.36 ± 0.50) d; t = 1.543, P = 0.128)] had no significant difference between the two groups, and the total cure rate of each group was 100%. One case with abscesses occured bleeding in PA group. No medical staff was exposed to infection.

Conclusions

Operation of precise treatment guided by ultrasound for AIDS patients with liver abscess was simple, with lower risk, higher cure rate and less complications.

Key words: Liver abscess, Ultrasonography, Acquired immunodeficiency syndrome

Xueping Yang, Yao Zhang, Lianshuang Wang, Liping Wang. Evaluation on efficacy and safety of precise treatment guided by ultrasound for acquired immune deficiency syndrome patients with liver abscess[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(03): 277-281.

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References 25

[1]	Al Amer NA, Abd El Maksoud WM. Abscess of the caudate lobe of the liver, a rare disease with a challenging management: a case report[J]. J Biomed Res,2013,27(5):430-434.
[2]	Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome?[J]. J Vasc Interv Radiol,2009,20(8):1059-1065.
[3]	李雪娇, 朱艳梅, 汪习成, 等. 艾滋病患者肝脏病变的彩色多普勒超声表现[J]. 中国超声医学杂志,2011,23(3):239-242.
[4]	Cerwenka H. Is surgery still needed for the treatment of pyogenic liver abscess?[J]. Dig Liver Dis,2008,40(8):697-698.
[5]	Dulku G, Mohan G, Samuelson S et al. Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review[J]. Australas Med J,2015,8(1):7-18.
[6]	中华医学会感染病学分会艾滋病学组. 艾滋病诊疗指南[J]. 中华传染病杂志,2006,24(2):133-144.
[7]	龙宏纲, 邝伟明, 朱郇荣. AIDS病人施行外科手术的安全性评价[J]. 中国艾滋病性病,2004,10(3):185-186.
[8]	Guild GN, Moore TJ, Barnes W, et al. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive[J]. Clin Orthop Relat Res,2012,470(5):1507-1512.
[9]	栾飞, 王辉. 超声引导穿刺置管引流与抽吸冲洗治疗肝脓肿的临床应用[J]. 中国介入影像与治疗学,2006,3(6):451-453.
[10]	廖伟, 畅智慧, 刘兆玉, 等. 经皮穿刺引流治疗肝脓肿12年临床经验[J]. 介入放射学杂志,2013, 22(10):843-847.
[11]	Singh S, Chaudhary P, Saxena N, et al. Treatment of liver abscess: prospective randomised comparison of catheter drainage and needle aspiration[J]. Ann Gastroenterol,2013,26(4):332-339.
[12]	Singh O, Gupta S, Moses S, et al. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses[J]. Indian J Gastroenterol,2009,28(3):88-92.
[13]	李建东. 经皮肝穿刺置管引流与经腹切开引流治疗细菌性肝脓肿的临床观察[J]. 河北医学,2015,21(4):561-563.
[14]	潘凡, 熊日晖, 潘晨, 等. 110例细菌性肝脓肿的诊断和治疗分析[J/CD]. 中华实验和临床感染病杂志(电子版),2013,7(1):43-46.
[15]	金秋龙, 黄敏, 邓学东, 等. 超声引导下经皮肝穿刺置管引流治疗肝脓肿并发症分析与防治[J]. 中国介入影像与治疗学,2008,5(3):180-182.
[16]	Alvarez-Uria G, Pakam R, Midde M, et al. Intra-abscess administration of antibiotics through ultrasound-guided percutaneous catheter for the treatment of pyogenic liver abscess[J]. J Clin Diagn Res,2013,7(8):1698-1699.
[17]	Luo M, Yang XX, Tan B, et al. Distribution of common pathogens in patients with pyogenic liver abscess in China: a meta-analysis[J]. Eur J Clin Microbiol Infect Dis,2016,35(10):1557-1565.
[18]	Basu S. Klebsiella pneumoniae: An Emerging Pathogen of Pyogenic Liver Abscess[J]. Oman Med J,2009,24(2):131-133.
[19]	郭晶晶, 王慧珠, 李娟, 等. 39例细菌性肝脓肿患者的病原学分布及耐药性分析[J/CD]. 中华实验和临床感染病杂志(电子版),2015,9(1):67-70.
[20]	Alsaif HS, Venkatesh SK, Chan DS, et al. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumonia[J]. Radiology,2011,260(1):129-138.
[21]	Chen YC, Lin CH, Chang SN, et al. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000-2011[J]. J Microbiol Immunol Infect,2016,49(5):646-653.
[22]	杨学平, 王丽萍, 罗艳, 等. 超声引导下介入治疗艾滋病合并肝脓肿的临床价值[J/CD]. 中国肝脏病杂志(电子版),2015,7(1):77-79.
[23]	Johnson VA, Calvez V, Gunthard HF, et al. 2011 update of the drug resistance mutations in HIV-1[J]. Topics Antiviral Med,2011,19(4):156-164.
[24]	Meyers DJ, Epling C, Dement J, Hunt D. Risk of sharp device-related blood and body fluid exposure in operating rooms[J]. Infect Control Hosp Epidemiol,2008,29(12):1139-1148.
[25]	孙胜, 张强, 赵昌松, 等. HIV感染者骨科手术中医务人员职业暴露和防护[J]. 中华实验和临床感染病杂志(电子版),2016,10(2):184-187.

指标		例（%）
临床表现
	高热寒战	33（75.00）
	低-中度发热	11（25.00）
	腹痛	32（72.73）
	食欲减退	22（50.00）
	体重下降	6（13.64）
	慢性腹泻	11（25.00）
	感染性休克	1（2.27）
实验室指标
	CD4⁺ T （< 200.0个/μl）	12（27.27）
	WBC > 10.0 × 10⁹/L	28（63.64）
	Hb < 120.0 g/L	32（72.73）
	AST > 40.0 U/L	18（40.91）
	ALT > 50.0 U/L	17（38.64）
	TBil > 18.8 μmol/L	10（22.73）
	ALB < 40.0 g/L	25（56.82）
	CRP > 5.0 mg/L	40（90.91）

指标		例（%）
临床表现
	高热寒战	33（75.00）
	低-中度发热	11（25.00）
	腹痛	32（72.73）
	食欲减退	22（50.00）
	体重下降	6（13.64）
	慢性腹泻	11（25.00）
	感染性休克	1（2.27）
实验室指标
	CD4⁺ T （< 200.0个/μl）	12（27.27）
	WBC > 10.0 × 10⁹/L	28（63.64）
	Hb < 120.0 g/L	32（72.73）
	AST > 40.0 U/L	18（40.91）
	ALT > 50.0 U/L	17（38.64）
	TBil > 18.8 μmol/L	10（22.73）
	ALB < 40.0 g/L	25（56.82）
	CRP > 5.0 mg/L	40（90.91）

指标	PA组（9例）	PCD组（35例）	统计量	P值
年龄（ ± s，岁）	36.56 ± 7.63	38.51 ± 9.49	t = 0.572	0.571
脓肿单发︰多发（例）	5︰4	28︰7	χ² = 1.164	0.281^a
高热寒战[例（%）]	6（66.67）	27（77.14）	χ² = 0.047	0.829^a
腹痛[例（%）]	6（66.67）	26（74.29）	χ² = 0.001	0.970^a
体重下降[例（%）]	1（11.11）	5（14.29）	χ² = 0.000	0.999^a
慢性腹泻[例（%）]	4（44.44）	7（20.00）	χ² = 1.164	0.281^a
感染性休克[例（%）]	0（0.00）	1（2.86）	-	0.999^b
CD4⁺ T（ ± s，个/μl）	375.22 ± 256.66	394.51 ± 244.37	t = 0.209	0.835
WBC（ ± s，× 10⁹/L）	10.76 ± 5.70	14.11 ± 12.02	t = 0.810	0.422
Hb（ ± s，g/L）	102.33 ± 19.56	108.95 ± 19.31	t = 0.941	0.366
AST > 40.0 U/L [例（%）]	5（55.56）	13（37.14）	χ² = 0.387	0.534^a
ALT > 50.0 U/L [例（%）]	4（44.44）	13（37.14）	χ² = 0.000	0.986^a
TBil（ ± s，μmol/L）	17.74 ± 12.36	13.74 ± 12.87	t = 0.838	0.407
ALB（ ± s，g/L）	35.23 ± 2.82	33.70 ± 5.53	t = 1.158	0.258
CRP（ ± s，mg/L）	147.89 ± 90.89	151.40 ± 100.70	t = 0.095	0.925

指标	PA组（9例）	PCD组（35例）	统计量	P值
年龄（ ± s，岁）	36.56 ± 7.63	38.51 ± 9.49	t = 0.572	0.571
脓肿单发︰多发（例）	5︰4	28︰7	χ² = 1.164	0.281^a
高热寒战[例（%）]	6（66.67）	27（77.14）	χ² = 0.047	0.829^a
腹痛[例（%）]	6（66.67）	26（74.29）	χ² = 0.001	0.970^a
体重下降[例（%）]	1（11.11）	5（14.29）	χ² = 0.000	0.999^a
慢性腹泻[例（%）]	4（44.44）	7（20.00）	χ² = 1.164	0.281^a
感染性休克[例（%）]	0（0.00）	1（2.86）	-	0.999^b
CD4⁺ T（ ± s，个/μl）	375.22 ± 256.66	394.51 ± 244.37	t = 0.209	0.835
WBC（ ± s，× 10⁹/L）	10.76 ± 5.70	14.11 ± 12.02	t = 0.810	0.422
Hb（ ± s，g/L）	102.33 ± 19.56	108.95 ± 19.31	t = 0.941	0.366
AST > 40.0 U/L [例（%）]	5（55.56）	13（37.14）	χ² = 0.387	0.534^a
ALT > 50.0 U/L [例（%）]	4（44.44）	13（37.14）	χ² = 0.000	0.986^a
TBil（ ± s，μmol/L）	17.74 ± 12.36	13.74 ± 12.87	t = 0.838	0.407
ALB（ ± s，g/L）	35.23 ± 2.82	33.70 ± 5.53	t = 1.158	0.258
CRP（ ± s，mg/L）	147.89 ± 90.89	151.40 ± 100.70	t = 0.095	0.925

指标	PA	PCD	统计量	P值
体温恢复时间（ ± s，d）	1.36 ± 0.50	1.60 ± 0.52	t = 1.543	0.128
脓腔闭合时间（ ± s，d）	9.14 ± 3.96	18.18 ± 8.73	t = 5.353	< 0.001
并发症[例（%）]	1（7.14）	0（0.00）		0.241^a
一次穿刺治愈[例（%）]	8（57.14）	44（100.00）		< 0.001^a
总治愈率（%）	100.00	100.00	-	-

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