| Objective 1.To analysis the clinical characteristics of patients with liver abscess,observe the effect of percutaneous drainage in the treatment of liver abscess,analysis factors affecting curative effect.2.After Klebsiella pneumoniae infection,comparing diabetic mice and normal mice liver inflammation pathology,cytokines and inflammatory signaling pathways protein expression differences,to explore molecular mechanism of high incidence of the diabetic mice klebsiella pneumoniae liver abscess.Method1.clinical data of 121 patients with liver abscess was collected in Interventional vascular surgery Shanghai 3 armour hospital in January 2011-January 2016.After CT evaluation of lesion liquefaction,liver puncture drainage under CT guidance was suffered at the same time of fully anti-infection,general data,laboratory examination,and the size of the abscess,and position,complications,pathogenic bacteria,the case fatality rate,complication rate,hospital stay after treatment and its influencing factors of patients are analyzed.2.(1)DM model construction: 48 healthy only 8 weeks of age male ICR mice,24 mice are selected randomly to construct diabetic model by intraperitoneal injection of 120 mg/kg of STZ.Control mice were treated with the same amount of citrate buffer without STZ.After 1 week mice blood sugar level is measured,mice with blood sugar > 20 tendency/L were considered as diabetic model mice.(2)Liver abscess model construction: After a month of the success of the DM model construction,3 x 10 *7 CFU / 50 ul pneumonia klebsiella bacteria bacterial suspension liquid is prepared,12 mice were selected randomly respectively from diabetes group and normal group mice,12 per mouse was infected with oral lavage Klebsiella pneumoniae suspension liquid of 3 x 10 * 8 CFU.Control mice were treated with the same amount of PBS without bacteria.(3)Experimental group: PBS-diabetes group,PBS-normal group,klebsiella pneumoniae-diabetes,klebsiella pneumoniae-normal group.(4)Hepatic histopathological examination: after 72 h of klebsiella pneumoniae infection in mice,the mice liver was removed,the degree of liver cell edema,inflammatory cells,abscess formation was observed by HE dyeing of PBS-diabetic group and PBS-normal group,klebsiella pneumoniae-diabetes,klebsiella pneumoniae-normal group.(5)The expression quantity of Mice liver inflammatory cytokine IL-1?,IL-2,IL-6,IL-10,MIP-1? ?TNF-? of four groups is compared by ELISA method.The expression quantity of I? ? ? ?I? ? ? ?I? B? ?NF-? B and Phosphorylation of them of four groups were obtained by Western blot observation.Result1.A total of 121 patients with liver abscess.2 patients appeared finally death,and the case fatality rate is 1.65%,and the factors influencing the case fatality rate is older age,basic diseases,diameter and solid components of the abscess.2 cases with peripheral hepatic abscess,abdominal abscess,piercing antrum discharging after Puncture drainage,the complication rate was 1.65%.The complications were dealed with actively until clinical cure.And factors affecting the rate of complications is mainly to be inappropriate for the surgical operation.119 patients achieved clinical cure,and cure rate is 98.34%.The average hospitalization time was(15.13±6.07)days.The risk factors affecting hospitalization time were : the number of abscess X1(r = 2.32,P = 2.32),abscess size X2(r = 0.26,P = 0.26),and white blood cell count X3(r = 0.238,P = 0.238).Multivariate linear regression equation of factors correlated with hospitalization time was statistically significant(P < 0.05),and the multiple regression equation is: Y = 3.438 + 3.055 X1 + 3.055 X2 + 0.297 X3,F = 5.819,R2 = 0.416.The influence of gender,age,diabetes,pathogenic bacteria,and abscess location on the length of hospital stay has no statistical difference(P > 0.05).2.After A week of STZ injection,24 mice blood glucose values of diabetes group tested by Glucose meter were > 20 tendency/L.Diabetic mice's hair was yellow and sparse.They drank more,ate more,urinated more,but thin,presenting "three more and one little " symptoms.Blood glucose in diabetes mice increased significantly compared with normal group(P < 0.05),and diabetes mellitus group and normal group mice weight has no obvious difference(P > 0.05).After mice infected with Klebsiella pneumoniae lavage,liver of mice in sterile conditions were given.HE dyeing experiment results show that the number of abscess formation of klebsiella pneumoniae-diabetes group was more than klebsiella pneumoniae-normal group(P < 0.05).ELISA experiment results show that The expression quantity of mice liver inflammatory cytokine IL-1?,IL-2,IL-6,IL-10,MIP-1? ?TNF-? of klebsiella pneumoniae-diabetes group was significantly higher than that of klebsiella pneumoniae-normal group(P < 0.05),and the expression quantity of mice liver inflammatory cytokine IL-1?,IL-2,IL-6,IL-10,MIP-1? ?TNF-? of klebsiella pneumoniae-diabetes group was significantly higher than that of PBS-diabetes group(P < 0.05),and the expression quantity of mice liver inflammatory cytokine IL-1?,IL-2,IL-6,IL-10,MIP-1? ?TNF-? of klebsiella pneumoniae-normal group was significantly higher than that of PBS-normal group(P < 0.05).Western blot experiment results show the expression quantity of I? ? ? ?I? ? ? ?I? B? ?NF-? B and Phosphorylation of them of klebsiella pneumoniae-diabetes group was significantly higher than that of klebsiella pneumoniae-normal group(P < 0.05),the expression quantity of I? ? ? ?I? ? ? ?I? B? ?NF-? B and Phosphorylation of them of klebsiella pneumoniae-diabetes group was significantly higher than that of klebsiella pneumoniae-diabetes group(P < 0.05),the expression quantity of I? ? ? ?I? ? ? ?I? B? ?NF-? B and Phosphorylation of them of klebsiella pneumoniae-normal group was significantly higher than that of PBS-normal group(P < 0.05).Conclusion1.Percutaneous puncture of liver abscess drainage is an effective method for treatment of liver abscess,with high cure rate,low complication and shorter hospitalization time,worthy of clinical popularization and application.Risk factors of diabetes indeed induce liver abscess,but when the blood sugar level is controled in the normal range,diabetes can not affect the length of hospitalization time.2.This experiment successfully constructed ICR mice's type 1 diabetes model and Klebsiella pneumoniae liver abscess model,and confirmed that the incidence of diabetic mice of klebsiella pneumoniae liver abscess increased.Its molecular mechanism is that the excessive activation of cells NF-? ? signaling pathwaysexpand the inflammation process,increase the degree of liver cell necrosis,then cause abscess incidence higher. |
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