肝衰竭合并感染热点难点问题探析

陈广; 陈韬; 宁琴

doi:10.3969/j.issn.1001-5256.2018.09.005

肝衰竭合并感染热点难点问题探析

DOI: 10.3969/j.issn.1001-5256.2018.09.005

华中科技大学同济医学院附属同济医院感染病研究所感染科

详细信息

中图分类号: R575.3
计量
- 文章访问数: 2107
- HTML全文浏览量: 44
- PDF下载量: 486
- 被引次数: 0
出版历程
- 收稿日期: 2018-07-04
- 出版日期: 2018-09-20

Hotspots and difficulties in the diagnosis and treatment of liver failure with infection

Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College of Huazhong University of Technology and Science

摘要

摘要: 肝衰竭是多种因素引起的严重肝损伤,感染是肝衰竭发生发展过程中最常见的并发症之一。肝衰竭患者合并感染病死率显著升高,是临床一线工作者面临的棘手问题。目前肝衰竭合并感染诊治的临床研究数据不充足,国内外亦无临床诊疗的指导性意见。对肝衰竭合并感染的流行状况、病理生理、诊断和治疗的难点热点进行了梳理总结,以期为临床诊疗提供指导,为进一步深入开展相关临床研究提供方向。
- 肝功能衰竭 /
- 感染 /
- 诊断 /
- 治疗学
Abstract: Liver failure is a serious liver damage caused by a variety of factors, and infection is one of the most common complications in the development and progression of liver failure. Liver failure patients with infection have a significant increase in mortality, which is a difficult clinical event for physicians. At present, there are no sufficient clinical data on the diagnosis and treatment of liver failure with infection, and there is also a lack of guidelines for clinical diagnosis and treatment in China and foreign countries. This article summarizes the difficulties and hotspots in the prevalence, pathophysiology, diagnosis, and treatment of liver failure with infection, in order to provide guidance for clinical diagnosis and treatment and directions for further clinical research.
- liver failure /
- infection /
- diagnosis /
- therapeutics

HTML全文

参考文献(40)

[1] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for diagnosis and treatment liver failure[J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[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[J].Gastroenterology, 2010, 139 (4) :1246-1256.

[3]FERNANDEZ J, ACEVEDO J, WIEST R, et al.Bacterial and fungal infections in acute-on-chronic liver failure:Prevalence, characteristics and impact on prognosis[J].Gut, 2017.[Epub ahead of print]

[4]NING Q.Acute exacerbation of chronic hepatitis B:Basic research and clinical management[M].Huazhong University of Science Technology Press, 2014. (in Chinese) 宁琴.乙型肝炎重症化基础与临床[M].华中科技大学出版社, 2014.

[5]GODBOLE G, SHANMUGAM N, DHAWAN A, et al.Infectious complications in pediatric acute liver failure[J].J Pediatr Gastroenterol Nutr, 2011, 53 (3) :320-325.

[6]CHOUDHURY A, KUMAR M, SHARMA BC, et al.Systemic inflammatory response syndrome in acute-on-chronic liver failure:Relevance of'golden window':A prospective study[J].J Gastroenterol Hepatol, 2017, 32 (12) :1989-1997.

[7]JHA AK, NIJHAWAN S, SUCHISMITA A.Sepsis in acute on chronic liver failure[J].Dig Dis Sci, 2011, 56 (4) :1245-1246.

[8]SARIN SK, CHOUDHURY A.Acute-on-chronic liver failure[J].Curr Gastroenterol Rep, 2016, 18 (12) :61.

[9]MANAKKAT VIJAY GK, RYAN JM, ABELES RD, et al.Neutrophil toll-like receptor 9 expression and the systemic inflammatory response in acetaminophen-induced acute liver failure[J].Crit Care Med, 2016, 44 (1) :43-53.

[10]SARIN SK, KEDARISETTY CK, ABBAS Z, et al.Acute-onchronic liver failure:Consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014[J].Hepatol Int, 2014, 8 (4) :453-471.

[11]WASMUTH HE, KUNZ D, YAGMUR E, et al.Patients with acute on chronic liver failure display"sepsis-like"immune paralysis[J].J Hepatol, 2005, 42 (2) :195-201.

[12]BERNSMEIER C, TRIANTAFYLLOU E, BRENIG R, et al.CD14 (+) CD15 (-) HLA-DR (-) myeloid-derived suppressor cells impair antimicrobial responses in patients with acute-on-chronic liver failure[J].Gut, 2018, 67 (6) :1155-1167.

[13]SCHLATTMANN P, BRUNKHORST FM.Procalcitonin as a diagnostic marker for sepsis[J].Lancet Infect Dis, 2014, 14 (3) :189.

[14]VINCENT JL, MORENO R, TAKALA J, et al.The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure.On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine[J].Intensive Care Med, 1996, 22 (7) :707-710.

[15]MA K, GUO W, HAN M, et al.Entecavir treatment prevents disease progression in hepatitis B virus-related acute-on-chronic liver failure:Establishment of a novel logistical regression model[J].Hepatol Int, 2012, 6 (4) :735-743.

[16]WAN YM, LI YH, XU ZY, et al.Tenofovir versus entecavir for the treatment of acute-on-chronic liver failure due to reactivation of chronic hepatitis B with genotypes B and C[J].J Clin Gastroenterol, 2018.[Epub ahead of print]

[17]GARG H, SARIN SK, KUMAR M, et al.Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure[J].Hepatology, 2011, 53 (3) :774-780.

[18]WILLIAM M, LEE M, LARSON AM, et al.AASLD position paper:The management of acute liver failure:Update[J].Hepatology, 2011:55.

[19]JALAN R, FERNANDEZ J, WIEST R, et al.Bacterial infections in cirrhosis:A position statement based on the EASL Special Conference 2013[J].J Hepatol, 2014, 60 (6) :1310-1324.

[20]VERMA A, AUZINGER G, KANTECKI M, et al.Safety and efficacy of anidulafungin for fungal infection in patients with liver dysfunction or multiorgan failure[J].Open Forum Infect Dis, 2017, 4 (1) :ofw241.

[21]LIMPER AH, KNOX KS, SAROSI GA, et al.An official American Thoracic Society statement:Treatment of fungal infections in adult pulmonary and critical care patients[J].Am J Respir Crit Care Med, 2011, 183 (1) :96-128.

[22]GARG V, GARG H, KHAN A, et al.Granulocyte colony-stimulating factor mobilizes CD34 (+) cells and improves survival of patients with acute-on-chronic liver failure[J].Gastroenterology, 2012, 142 (3) :505-512.e1.

[23]SAHA BK, MAHTAB MA, AKBAR SMF, et al.Therapeutic implications of granulocyte colony stimulating factor in patients with acute-on-chronic liver failure:Increased survival and containment of liver damage[J].Hepatol Int, 2017, 11 (6) :540-546.

[24]SINGH V, KEISHAM A, BHALLA A, et al.Efficacy of granulocyte colony-stimulating factor and N-acetylcysteine therapies in patients with severe alcoholic hepatitis[J].Clin Gastroenterol Hepatol, 2018.[Epub ahead of print]

[25]DUAN XZ, LIU FF, TONG JJ, et al.Granulocyte-colony stimulating factor therapy improves survival in patients with hepatitis B virus-associated acute-on-chronic liver failure[J].World J Gastroenterol, 2013, 19 (7) :1104-1110.

[26]SUN ZJ, HU JH.Research advances in granulocyte colony-stimulating factor in treatment of liver failure[J].Chin Hepatol, 2014, 19 (10) :787-789. (in Chinese) 孙子健, 胡瑾华.粒细胞集落刺激因子治疗肝功能衰竭机制研究进展[J].肝脏, 2014, 19 (10) :787-789.

[27]SJOGREN MH.Thymalfasin:An immune system enhancer for the treatment of liver disease[J].J Gastroenterol Hepatol, 2004, 19 (12) :s69-s72.

[28]NAIR J, KUMAR VHS.Liver failure and conjugated hyperbilirubinemia in a preterm neonate:Role of early IVIG and exchange transfusion[J].AJP Rep, 2018, 8 (2) :e95-e98.

[29]BERNSMEIER C, SINGANAYAGAM A, PATEL VC, et al.Immunotherapy in the treatment and prevention of infection in acute-onchronic liver failure[J].Immunotherapy, 2015, 7 (6) :641-654.

[30]ARROYO V, GARCIA-MARTINEZ R, SALVATELLA X.Human serum albumin, systemic inflammation, and cirrhosis[J].JHepatol, 2014, 61 (2) :396-407.

[31]O'BRIEN AJ, FULLERTON JN, MASSEY KA, et al.Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2[J].Nat Med, 2014, 20 (5) :518-523.

[32]CHINA L, MAINI A, SKENE SS, et al.Albumin counteracts immune-suppressive effects of lipid mediators in patients with advanced liver disease[J].Clin Gastroenterol Hepatol, 2018, 16 (5) :738-747.e7.

[33] CHEN Y, JI F, GUO J, et al.Dysbiosis of small intestinal microbiota in liver cirrhosis and its association with etiology[J].Sci Rep, 2016, 6:34055.

[34]GONG S, LAN T, ZENG L, et al.Gut microbiota mediates diurnal variation of acetaminophen induced acute liver injury in mice[J].JHepatol, 2018, 69 (1) :51-59.

[35]BAJAJ JS, KASSAM Z, FAGAN A, et al.Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy:Arandomized clinical trial[J].Hepatology, 2017, 66 (6) :1727-1738.

[36]CRUM-CIANFLONE NF, SULLIVAN E, BALLON-LANDA G.Fecal microbiota transplantation and successful resolution of multidrug-resistant-organism colonization[J].J Clin Microbiol, 2015, 53 (6) :1986-1989.

[37]FERNANDEZ J, TANDON P, MENSA J, et al.Antibiotic prophylaxis in cirrhosis:Good and bad[J].Hepatology, 2016, 63 (6) :2019-2031.

[38]WIEST R, KRAG A, GERBES A.Spontaneous bacterial peritonitis:Recent guidelines and beyond[J].Gut, 2012, 61 (2) :297-310.

[39]CHAVEZ-TAPIA NC, BARRIENTOS-GUTIERREZ T, TELLEZ-AVILA F, et al.Meta-analysis:Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding-an updated Cochrane review[J].Aliment Pharmacol Ther, 2011, 34 (5) :509-518.

[40]BAJAJ JS, ANANTHAKRISHNAN AN, HAFEEZULLAH M, et al.Clostridium difficile is associated with poor outcomes in patients with cirrhosis:A national and tertiary center perspective[J].Am J Gastroenterol, 2010, 105 (1) :106-113.

施引文献

资源附件(0)

访问统计