肺炎克雷伯杆菌性肝脓肿眼内炎31例

doi:10.6040/j.issn.1673-3770.0.2020.227

摘要/Abstract

摘要： 目的探讨肺炎克雷伯杆菌性肝脓肿眼内炎的临床特征。方法收集来自眼科、肝胆外科、内分泌科、血液内科及呼吸内科收治的肺炎克雷伯杆菌性肝脓肿眼内炎的患者共31例(37眼)临床资料,分析患者一般资料、眼部查体、辅助检查、治疗及预后情况。结果患者主要为中老年男性,多数合并糖尿病。10眼无眼部症状,在行眼部检查时发现眼内炎表现。22眼行玻璃体腔注药术,12眼行玻璃体切除联合硅油填充术,10眼经治疗后视力提升,6眼最终行眼内容剜除术。结论肺炎克雷伯杆菌性肝脓肿眼内炎早期症状不典型,糖尿病及全身感染较重是其危险因素。部分患者早期无眼部症状,在行眼科检查时发现眼内炎表现,及时给予有效治疗从而得以保留较好视力。对无眼部症状的肝脓肿患者行眼科检查对于发现无症状眼内炎患者并给予及时有效治疗有重要意义,有助于保存视力,改善预后。

关键词: 内源性眼内炎, 肝脓肿, 肺炎克雷伯杆菌, 糖尿病, 无症状, 治疗

Abstract: Objective To analyze the clinical characteristics of endogenous endophthalmitis(EE)associated with Klebsiella pneumoniae pyogenic liver abscess(KPPLA). Methods A retrospective analysis was performed, which included 31 patients(37 eyes)with EE associated with KPPLA admitted to the Yantai Yuhuangding Hospital affiliated to Qingdao University from 2013 to 2020. These patients were treated in the department of ophthalmology, hepatopancreatobiliary surgery, endocrinology, hematopathology, or respiratory medicine. General information, ophthalmologic findings, laboratory test results, etiology, imaging findings, treatment, and prognosis were analyzed. Results Most the 31 patients were middle-aged or elderly men, and most were diagosed with diabetic mellitus. Ten of the 37 eyes had no symptoms, which were diagnosed as EE during ocular examination. Twenty-two eyes were treated with an intravitreal injection, and 12 eyes were treated with vitrectomy. Ten eyes had improved visual acuity after treatment, while six eyes were enucleated. Conclusions Early symptoms of EE associated with KPPLA were atypical. Diabetes and severe systemic infection were the risk factors. Some patients had no ocular clinical manifestations in the early stage, and endophthalmitis was found in the ophthalmologic examination. Early ophthalmologic examination is important to detect asymptomatic EE. Timely and effective treatment can help preserve the patient's useful vision and improve the prognosis.

Key words: endogenous endophthalmitis, pyogenic liver abscess, Klebsiella pneumoniae, diabetic mellitus, asymptomatic, therapy

中图分类号:

R771.2

蒲雅迪,李元彬. 肺炎克雷伯杆菌性肝脓肿眼内炎31例[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 95-98.

PU Yadi, LI Yuanbin. Endogenous endophthalmitis associated with Klebsiella pneumoniae pyogenic liver abscess: a report of 31 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 95-98.

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