肝硬化并发细菌感染诊断与治疗研究进展

doi:10.3969/j.issn.1672-5069.2017.04.038

摘要/Abstract

摘要： 细菌感染是肝硬化患者常见的并发症,一旦出现感染,病情容易进展为肝衰竭和多器官功能衰竭而死亡。肝硬化并发细菌感染早期不易发现,缺乏敏感性及特异性较高的诊断办法。另外,近年来细菌耐药性的不断增加,使得肝硬化并发细菌感染的发病率及病死率仍处于较高的水平。本文重点介绍了肝硬化患者并发细菌感染的临床类型、细菌谱变化、诊断的难点和目前的治疗策略。

关键词: 肝硬化, 细菌感染, 诊治

Abstract: Bacterial infection is a common complications in patients with liver cirrhosis. Once the patients with liver cirrhosis got bacterial infections,the disease might progress quickly to liver failure,multiple organ failure and the mortality was high,which might be due to latent onset,difficult early diagnosis and the growing spread of multi-resistant pathogens. In this reviews,we will take focus on the clinical types of infections, the consequences of infections,the changes of bacterial spectrum, and the strategies in diagnosis and the current treatment.

Key words: Liver cirrhosis, Bacteria infection, Diagnosis, Therapy

徐晶晶, 翁亚丽. 肝硬化并发细菌感染诊断与治疗研究进展[J]. 实用肝脏病杂志, 2017, 20(4): 509-512.

Xu Jingjing, Weng Yali.. Recent advances in diagnosis and treatment of patients with liver cirrhosis and bacterial infection[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 509-512.

参考文献

[1] Jalan R,Fernandez J,Wiest R,et al. Bacterial infections in cirrhosis:a position statement based on the EASL Special Conference 2013. J Hepatol,2014,60（6）:1310-1324.
[2] Arvaniti V,D'Amico G,Fede G,et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology,2010,139（4）:1246-1256.
[3] Hung TH,Tseng CW,Hsieh YH,et al. High mortality of pneumonia in cirrhotic patients with ascites. BMC Gastroenterol,2013,13（1）:25.
[4] Bajaj JS,O'Leary JG,Reddy KR,et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology,2014,60（1）:250-256.
[5] Shawcross DL,Davies NA,Williams R,et al. Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonemia in cirrhosis. J Hepatol,2004,40（2）:247-254.
[6] Terra C,Guevara M,Torre A,et al. Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis:value of MELD score. Gastroenterology,2005,129（6）:1944-1953.
[7] Harry R,Auzinger G,Wendon J. The clinical importance of adrenal insufficiency in acute hepatic dysfunction. Hepatology,2002,36（2）:395-402.
[8] Taneja SK,Dhiman RK. Prevention and management of bacterial infections in cirrhosis. Int J Hepatol,2011,2011:784540.
[9] Pleguezuelo M,Benitez JM,Jurado J,et al. Diagnosis and management of bacterial infections in decompensated cirrhosis. World J Hepatol,2013,5（1）:16-25.
[10] 危贵君,胡奕. 肝硬化患者医院感染病原菌分布及危险因素分析. 中华医院感染学杂志,2012,23（2）:278-279.
[11] 汪鑫,彭春仙,叶程军,等. 肝硬化患者医院感染的危险因素分析与预防. 中华医院感染学杂志,2015,26（1）:169-170.
[12] Yoshida H,Hamada T,Inuzuka S,et al. Bacterial infection in cirrhosis,with and without hepatocellular carcinoma. Am J Gastroenterol,1993,88（12）:2067-2071.
[13] Caly W R,Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol,1993,18（3）:353-358.
[14] Fernández J,Navasa M,Gómez J,et al. Bacterial infections in cirrhosis:epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology,2002,35（1）:140-148.
[15] Fernández J,Acevedo J,Castro M,et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis:a prospective study. Hepatology,2012,55（5）:1551-1561.
[16] Acevedo J,Silva A,Prado V,et al. The new epidemiology of nosocomial bacterial infections in cirrhosis:therapeutical implications. Hepatol Int,2013,7（1）:72-79.
[17] Merli M,Lucidi C,Di Gregorio V,et al. The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis:a prospective survey. PLoS One,2015,10（5）:e127448.
[18] Merli M,Lucidi C. Bacterial resistance in cirrhotic patients: an emerging reality. J Hepatol,2012,56（4）:756-757.
[19] Ariza X,Castellote J,Lora-Tamayo J,et al. Risk factors for resistance to ceftriaxone and its impact on mortality in community,healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol,2012,56（4）:825-832.
[20] 蔡均均,韩涛. 2013年欧洲肝病学会肝硬化细菌感染立场声明的概述. 临床肝胆病杂志,2014,30（7）:588-591.
[21] 南月敏,牛学敏. 肝硬化并发感染的早期识别与经验性治疗. 临床肝胆病杂志,2015,31（3）:349-353.
[22] Lin KH,Wang FL,Wu MS,et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis:a systematic review and meta-analysis. Diagn Microbiol Infect Dis,2014,80（1）:72-78.
[23] Cai ZH,Fan CL,Zheng JF,et al. Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis. BMC Infect Dis,2015,15（1）:1-7.
[24] Papp M,Vitalis Z,Altorjay I,et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections. Liver Int,2012,32（4）:603-611.
[25] Ferrer R,Martin-Loeches I,Phillips G,et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour:results from a guideline-based performance improvement programe. Crit Care Med,2014,42（8）:1749-1755.
[26] Arabi YM,Dara SI,Memish Z,et al. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. Hepatology,2012,56（6）:2305-2315.
[27] Dever J B,Sheikh M Y. Review article:spontaneous bacterial peritonitis-bacteriology,diagnosis,treatment,risk factors and prevention. Aliment Pharmacol Ther,2015,41（11）:1116-1131.
[28] EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis. J Hepatol,2010,53（3）:397-417.
[29] Viasus D,Garcia-Vidal C,Carratalà J. Advances in antibiotic therapy for community-acquired pneumonia. Curr Opin Pulm Med,2013,19（3）: 209-215.
[30] 产超广谱β-内酰胺酶细菌感染防治专家委员会.产超广谱β-内酰胺酶细菌感染防治专家共识. 中华实验和临床感染病杂志（电子版）,2010,4（2）: 207-214.
[31] 中华医学会呼吸病学分会感染学组.甲氧西林耐药的金黄色葡萄球菌肺炎诊治与预防专家共识.中华结核和呼吸杂志,2012,35（10）: 734-738.
[32] Acevedo J,Prado V,Fernández J. Changing options for prevention and treatment of infections in cirrhosis. Curr Treat Options Gastroenterol,2014,12（2）:256-267.
[33] Fernández J,Gustot T. Management of bacterial infections in cirrhosis. J Hepatol,2012,56（Suppl 1）: S1.
[34] Pleguezuelo M,Benitez JM,Jurado J,et al. Diagnosis and management of bacterial infections in decompensated cirrhosis. World J Hepatol,2013,5（1）:16-25.
[35] Bernardi M,Ricci CS,Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol,2014,4（4）:302-311.
[36] Thévenot T,Bureau C,Oberti F,et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. J Hepatol,2015,62（4）:822-830.