Study On The Characteristics Of Type 2 Diabetes With Liver Abscess

Objective:To explore the difference of clinical characteristics of liver abscess(LA)between patients with and without type 2 diabetes mellitus(T2DM).Methods:We included 482 LA patients treated at Jiangsu Province Hospital from January 2011 to December 2016,retrospectively.The patients were divided into DM group(202 cases)and non-DM group(280 cases).Clinical characteristics,laboratory,treatment,prognosis,image documents and microbiological data of these patients were comparatively analyzed.We applied chi-square,Fisher's exact tests,student t tests and Mann-Whitney U tests to evaluate the differences between the two groups.Results:Of the 482 patients included,202(41.9%)had DM.The mean age of the DM group is higher than the non-DM group.LA patients with T2DM had higher prevalence rates of pleural effusion,reactive pleurisy,abscess rupture,lethargy,but lower prevalence rates of malignancy,right upper quadrant pain.For laboratory and image findings,LA patients with T2DM had higher level of blood urea nitrogen(BUN),creatinine(Cr),aspartate aminotransferase(AST),glucose,but lower level of serum albumin.The liver absecess size>10cm was more common in the DM group.For microbiological data,the most common organism identified in the DM group was Klebsiella pneumonia(KP)in pus cultures,but Escherichia coli was less frequently isolated from pus cultures of the DM group.Conclusions:LA patients with and without DM have different clinical characteristics,and the DM group is more difficult to diagnose and treatment.Inflammatory predictor such as C-reactive protein(C-CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR)are conducive to diagnosis.Besides,the LA with T2DM have more complications,which is to increase the difficulty of treatment.The most common organism identified in the DM group was Klebsiella pneumonia(KP),treatment should be focused on effective control of serum glucose,timely liver puncture treatment,adequate use of antibiotics to improve the effect of treatment.Objective:To explore the pathogens and drug-resistance in adult patients with liver abscess(LA).Methods:We included 202 LA patients with pathogens and drug susceptibility test results treated at Jiangsu Province Hospital from March 2009 to February 2017,retrospectively.215 pathogens were identified in the blood or pus cultures of 202 LA patients.Clinical characteristics,pathogens,drug susceptibility test results,prognosis of these patients were collected and analyzed.We applied descriptive analysis to expound the characteristics of pathogens.Results:1.Of the 215 pathogens included in adult patients with liver abscess,the most common organism identified was Klebsiella pneumonia(KP)(67.0%),but Escherichia coli was less frequently isolated(13.0%).Of the 27 gram-positive bacteria,Streptococcus and Enterococcus accounted for 5.6%and 4.2%respectively.Cultured fungi in the LA patients were all Candida.2.The drug-resistance rate of KP to piperacillin was more than 50%.The drug-resistance rate of E.coli to ampicillin,piperacillin,aztreonam,cotrimoxazole,levofloxacin,cefazolin,and cefuroxime were more than 50%.Besides,the susceptibility rate of E.coli to third and fourth generation cephalosporins,such as cefotaxime,ceftazidime and cefepime were less than 60%.In addition,the drug-resistance rate to ?-lactam was obviously higher than?-lactam with enzyme inhibitor in KP and E.coli.The susceptibility rate of gram-positive bacteria to penicillin were less than 60%.The susceptibility rate of fungi to amphotericin B was 100%.3.The mortality of non-Klebsiella pneumoniae liver abscess was higher than Klebsiella pneumoniae liver abscess.The mortality of fungi and E.coli liver abscess was 60.0%and 17.9%respectively.Conclusions:The most common organism identified in LA patients was Klebsiella pneumonia,followed by Escherichia coli.The ?-lactam with tazobactam and carbapenem antibiotic still keep a high antibacterial activity,which could be used as selection of empiric antibacterial therapy in LA patients.The mortality of non-Klebsiella pneumoniae liver abscess was higher,clinical doctors should pay more attention to those.Objective:To investigate plasma interleukin-22 expression and clinical significance in liver abscess patients with diabetes mellitus.Methods:Plasma was obtained from 20 cases of type 2 diabetes mellitus and 20 cases of liver abscess.Plasma from 10 healthy donors was also collected as control.Plasma IL-22 levels were measured by enzyme-linked immunosorbent assay(ELISA)method.Difference between groups was determined bu unpaired t test.Results:The IL-22 levels of plasma in type 2 diabetes mellitus patients[(l 15.2± 17,04)pg/mL],liver abscess patients[(l 16.2± 16.43)pg/mL] were lower significantly compared with that of healthy controls[(161.7±23.22)pg/mL](p<0.01).The IL-22 levels of plasma in liver abscess patients with diabetes mellitus[(123.1 ± 13.96)pg/mL] were higher than that of liver abscess patients without diabetes mellitus[(103.3±13.00)pg/mL],The difference between tow groups were statistically significant(P<0.01).Conclusions:The IL-22 levels of plasma in type 2 diabetes mellitus patients,liver abscess patients and liver abscess patients with diabetes mellitus were lower significantly compared with that of healthy controls.The IL-22 levels of plasma in liver abscess patients without diabetes mellitus were lower significantly compared to liver abscess patients with diabetes mellitus.