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頁籤選單縮合
題名 | 年輕成人的肝膿瘍:愛滋病毒感染的線索?=Liver Abscess in Young Adults: A Clue of HIV Infection? |
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作者 | 王蒼恩; 林錫泉; 張文熊; 高進祿; 施壽全; 周孫衍; 王鴻源; 朱正心; 劉泰成; 李聰明; | 書刊名 | 內科學誌 |
卷期 | 13:4 2002.08[民91.08] |
頁次 | 頁194-199 |
分類號 | 415.53 |
關鍵詞 | 肝膿瘍; 愛滋病毒; 愛滋病; 肺炎克雷白氏桿菌; 化膿性肝膿瘍; 阿米巴性肝膿瘍; Liver abscess; Human immunodeficiency virus; HIV; Acquired immunodeficiency syndrome; AIDS; Klebsiella pneumoniae; Pyogenic liver abscess; Amoebic liver abscess; |
語文 | 中文(Chinese) |
中文摘要 | 肝膿瘍病例好發於中老年人,年輕成人發生肝膿瘍之機會甚低,可能另有特殊成因;臺灣近年來愛滋病毒感染人數漸增,且多集中在年輕成人。兩者是否有關?故做以下回溯性研究。收集1990年七月至2001年六月中20至35歲因肝膿瘍住院病例,整理性別、疾 病史、致病因素、實驗室檢查、膿瘍位置、致病菌、治療狀況與預後等,並特別注意HIV抗體檢測。結果:符合條件之病例共66例,佔所有成人肝膿瘍的10.6%。男女比2.5:1。其中12%併有糖尿病,膽道疾病、血液疾病各有9%,3例有癌症,另6例是外傷、肝硬化與先天性心臟病,39例無特殊過去病史。初始症狀以發燒、畏寒、右上腹疼痛為主。60例為細菌性膿瘍,餘6例為阿米巴性膿瘍。膿傷以單一病灶,和在肝右葉居多。血液與膿液細菌培養陽性率為19%與64%。肺炎克雷白氏桿菌最常見。治療方式包括單獨用抗生素(17%),或合併超音波指引抽吸(14%),電腦斷層攝影引流(50%),或手術引流(19%)。直接與肝膿瘍相關之死亡有5例。66例中19例有檢測HIV,陽性反應三例,佔檢驗病例之15.8%,所有病例之4.5%。三例病例皆處於愛滋感染早期。 年輕成人發生肝膿瘍的原因與中老年人不同,無明顯危險因子佔多數。阿米巴肝膿瘍將近一成,細菌性膿瘍培養陽性率較低,但仍以肺炎克雷白氏桿菌居首。此外有45%患者感染HIV,且無特殊症狀,所以HIV應列為年輕成人肝膿瘍的必要檢查項目。 |
英文摘要 | Liver abscess commonly occurs in middle and old age, unusual in young adult, there might be a few distinctive marks. In Taiwan, most of HIV infections were young adult. Therefore, is there a relationship between the HIV infection and hepatic abscess? From July 1990 to June 2001, we recorded the patients with liver abscess that were between 20 and 35 year-old, and analyzed their history and clinical data, method of treatment, and more emphasized the result of HIV test. There were 66 patients enrolled in this study, about 10.6% of all liver abscess cases in our hospital. Ratio of man and woman was 2.47:1. 12% patients had diabetes; biliary tract disorder and hematological disease were 9% respectively, 3 patients had cancer. 6 cases were associated with trauma, cirrhosis or congenital heard disease. 39 patients didn't have specific history. Fever, chill and right upper abdominal pain were the most initial symptoms. 60 cases were pyogenic abscess and 6 cases were amoebic abscess. Most of abscesses were single and 85% located in the right lobe liver. Positive culture of blood and pus were 19% and 64%, Klebsiella pneumoniae was 42%. In treatment, 17% patients used antibiotics only, 14% with echoguide aspiration, half of cases received drainage by CT guide, and another 19% received surgical drainage or resection. 5 patients died with association of liver abscess. 19 of 66 patients had checked HIV antibody. Although only three patients were positive, it is about 15.8% of tested cased and 4.5% of this study. The three patients were in the early stage of HIV infection. Predisposed factor of liver abscess in young adult is different from old age; most of them had not specific systemic disease. About 9% of them were amoebic abscess, higher than general population in Taiwan. Although the positive rate of bacterial culture was slightly low, Klebsiella pneumonae still was the most common cause. However, there were more than 4.5% patients with HIV infection and without flare out of AIDS. HIV test should be done if young adult got liver abscess. |
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