肝胆系统疾病患者胆汁病原菌分布与临床特征

Distribution of pathogens from bile and clinical characteristics of patients with hepatobiliary diseases

摘要:

目的了解肝胆系统疾病患者胆汁分离病原菌情况及临床特征。方法采用回顾性研究方法，收集和分析某院肝胆疾病患者胆汁标本细菌培养结果及相关临床资料。结果共收集肝胆系统疾病患者胆汁标本406份，培养阳性率为64.53%，262份阳性标本中分离单一病原菌的占62.21%（163份），2种病原菌的占32.83%（86份），3种病原菌的占4.96%（13份）。分离病原菌374株，其中革兰阴性菌242株（64.71%），革兰阳性菌131 株（35.02%），真菌1株（0.27%）。肝硬化、既往有肝胆手术史、患胆道结石者胆汁分离病原菌阳性率均高于对照组（均P＜0.05），胆道系统不同部位结石患者的胆汁病原菌分离阳性率有差异；而不同年龄、性别、以及是否患肝胆肿瘤各组比较，差异均无统计学意义（均P＞0.05）。胆道系统有无结石、既往有无手术史患者胆汁分离病原菌种类构成比较，差异无统计学意义（均P＞0.05）；而肝硬化患者与无肝硬化患者胆汁分离病原菌种类构成比较，差异有统计学意义（χ2=14.058，P=0.001）。结论肝胆系统疾病患者胆汁分离菌以肠杆菌科细菌及肠球菌属细菌单一感染为主，肝胆系统结石患者、既往肝胆手术患者及肝硬化患者胆汁分离病原菌阳性率较高。

Abstract:

ObjectiveTo investigate isolation of pathogens from bile and clinical characteristics of patients with hepatobiliary diseases. MethodsBacterial culture result of bile and related clinical data of patients with hepatobiliary diseases in a hospital were collected and analyzed by retrospective survey. ResultsA total of 406 bile specimens from patients with hepatobiliary diseases were collected, the positive rate of culture was 64.53%. Of 262 positive specimens, 62.21%（n=163）, 32.83%（n=86）, and 4.96%（n=13） were isolated single pathogen, 2 kinds of pathogens，and 3 kinds of pathogens respectively. 374 pathogenic strains were isolated, 242（64.71%）, 131 （35.02%）, and 1（0.27%）were gramnegative bacteria, grampositive bacteria, and fungus respectively. Patients with cirrhosis of liver, history of hepatobiliary surgery, and cholelithiasis had higher isolation rates of pathogens from bile than control group(all P<0.05), isolation rates of pathogens from bile in patients with cholelithiasis of different sites were varied; but there was no significant differences among patients of different age, gender, and whether or not with hepatobiliary tumors(all P>0.05). There were no statistical difference in constitute of pathogenic species from bile between patients with and without gallstones, as well as with and without history of hepatobiliary surgery（both P＞0.05）；while constitute of pathogenic species from bile between patients with and without cirrhosis of liver was statistically different（χ2=14.058，P=0.001）. ConclusionPathogens from bile in patients with hepatobiliary diseases are mainly Enterobacteriaceae and Enterococcus spp. which caused single infection. Positive culture rate of pathogens from bile is higher in patients with cholelithiasis, history of hepatobiliary surgery, and liver cirrhosis.