肝硬化腹腔感染的诊疗进展及挑战

黎倍伶; 陈金军

doi:10.3969/j.issn.1001-5256.2021.04.003

肝硬化腹腔感染的诊疗进展及挑战

DOI: 10.3969/j.issn.1001-5256.2021.04.003

黎倍伶¹,
陈金军^{1, 2, ,}

1.
南方医科大学南方医院肝病中心，广州 510515
2.
南方医科大学南方医院增城分院肝病中心，广州 510515

基金项目:

科技部病毒性肝炎及艾滋病等传染病重大专项 (2018ZX10723203)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：黎倍伶负责撰写论文及文献收集；陈金军指导撰写文章并对文章内容最后定稿。

详细信息

作者简介:
黎倍伶(1991—)，女，医学博士，主要从事肝硬化感染相关研究

通信作者:
陈金军，chjj@smu.edu.cn

中图分类号: R575.2
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- 文章访问数: 585
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-25
- 录用日期: 2021-01-04
- 出版日期: 2021-04-20

Diagnosis and treatment of abdominal infection in patients with liver cirrhosis: Advances and challenges

Beiling LI¹,
Jinjun CHEN^{1, 2
, ,}

1.
Liver Disease Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
2.
Liver Disease Center, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

摘要

摘要: 感染是终末期肝病最常见并发症，其中，腹腔感染为最常见感染类型之一。腹水培养阳性率低，腹腔感染的诊断主要基于腹水多核细胞计数，治疗以经验性抗菌素使用为主。腹腔感染的诊断标准对临床实践指导意义有限，目前尚无可转化应用于临床实践的新型诊断标志物。病原体诊断方面，宏基因组二代测序为潜在快速识别肝硬化腹腔感染病原体或复合感染的新方法。治疗上，中国肝硬化腹水管理指南主要强调抗菌素的治疗，对联合输注人血白蛋白的剂量无明确推荐。肝硬化腹腔感染的诊断和治疗上仍面临巨大的挑战，未来需要更多相关的研究，包括优化腹腔感染诊断、预防、治疗等，进一步回答相关的临床问题，从而更好指导临床实践。
- 肝硬化 /
- 腹腔内感染 /
- 诊断 /
- 治疗学
Abstract: Infection is the most common complication in patients with end-stage liver disease, among which abdominal infection is the most common type. There is a low positive rate of ascitic fluid culture, and abdominal infection is mainly diagnosed based on multinucleated cell count in ascites and is mainly treated by empirical antimicrobial therapy. The diagnostic criteria for abdominal infection have limited guiding significance in clinical practice, and currently there are still no new diagnostic markers that can be used in clinical practice. For the pathogenic diagnosis of abdominal infection, metagenomic next-generation sequencing is a new technique for rapid identification of pathogens of abdominal infection or overlap infection in liver cirrhosis. In terms of treatment, Chinese guidelines on the management of ascites in cirrhosis emphasize antimicrobial therapy and give no explicit recommendation for the dose of human serum albumin infusion. There are still great challenges in the diagnosis and treatment of abdominal infection in cirrhotic patients, and more studies are needed in the future to answer relevant questions and better guide clinical practice, including the optimization of the diagnosis, prevention, and treatment of abdominal infection.
- Liver Cirrhosis /
- Intraabdominal Infections /
- Diagnosis /
- Therapeutics

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图 1 SBP诊断标准的演变历程

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参考文献(21)

[1]	PIANO S, BROCCA A, MARESO S, et al. Infections complicating cirrhosis[J]. Liver Int, 2018, 38(Suppl 1): 126-133. DOI: 10.1111/liv.13645.
[2]	SIMONETTO DA, PICCOLO SERAFIM L, GALLO DE MORAES A, et al. Management of sepsis in patients with cirrhosis: Current evidence and practical approach[J]. Hepatology, 2019, 70(1): 418-428. DOI: 10.1002/hep.30412.
[3]	MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144(7): 1426-1437.e1-e9. DOI: 10.1053/j.gastro.2013.02.042.
[4]	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.e1-e5. DOI: 10.1053/j.gastro.2010.06.019.
[5]	PIANO S, SINGH V, CARACENI P, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide[J]. Gastroenterology, 2019, 156(5): 1368-1380.e10. DOI: 10.1053/j.gastro.2018.12.005.
[6]	RUNYON BA, SQUIER S, BORZIO M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis[J]. J Hepatol, 1994, 21(5): 792-796. DOI: 10.1016/s0168-8278(94)80241-6.
[7]	FERNÁNDEZ J, PRADO V, TREBICKA J, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe[J]. J Hepatol, 2019, 70(3): 398-411. DOI: 10.1016/j.jhep.2018.10.027.
[8]	EVANS LT, KIM WR, POTERUCHA JJ, et al. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites[J]. Hepatology, 2003, 37(4): 897-901. DOI: 10.1053/jhep.2003.50119.
[9]	European Association for the Study of the Liver. EASL Clinical Practice Guideline: Occupational liver diseases[J]. J Hepatol, 2019, 71(5): 1022-1037. DOI: 10.1016/j.jhep.2019.08.008.
[10]	RUNYON BA, AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J]. Hepatology, 2013, 57(4): 1651-1653. DOI: 10.1002/hep.26359.
[11]	LI BL, GAO YH, WANG XB, et al. Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study[J]. Liver Int, 2020, 40(6): 1447-1456. DOI: 10.1111/liv.14418.
[12]	BUCSICS T, SCHWABL P, MANDORFER M, et al. Prognosis of cirrhotic patients with fungiascites and spontaneous fungal peritonitis (SFP)[J]. J Hepatol, 2016, 64(6): 1452-1454. DOI: 10.1016/j.jhep.2016.01.039.
[13]	AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L, et al. High serum lipopolysaccharide binding protein is associated with increased mortality in patients with decompensated cirrhosis[J]. Liver Int, 2017, 37(4): 576-582. DOI: 10.1111/liv.13264.
[14]	FERNANDES SR, SANTOS P, FATELA N, et al. Ascitic calprotectin is a novel and accurate marker for spontaneous bacterial peritonitis[J]. J Clin Lab Anal, 2016, 30(6): 1139-1145. DOI: 10.1002/jcla.21994.
[15]	ICHOU L, CARBONELL N, RAUTOU PE, et al. Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis[J]. Gut, 2016, 65(3): 536-538. DOI: 10.1136/gutjnl-2015-310160.
[16]	BRUNS T, SACHSE S, STRAUBE E, et al. Identification of bacterial DNA in neutrocytic and non-neutrocytic cirrhotic ascites by means of a multiplex polymerase chain reaction[J]. Liver Int, 2009, 29(8): 1206-1214. DOI: 10.1111/j.1478-3231.2009.02073.x.
[17]	FORBES JD, KNOX NC, RONHOLM J, et al. Metagenomics: The next culture-independent game changer[J]. Front Microbiol, 2017, 8: 1069. DOI: 10.3389/fmicb.2017.01069.
[18]	FERNÁNDEZ J, TANDON P, MENSA J, et al. Antibiotic prophylaxis in cirrhosis: Good and bad[J]. Hepatology, 2016, 63(6): 2019-2031. DOI: 10.1002/hep.28330.
[19]	MOREAU R, ELKRIEF L, BUREAU C, et al. Effects of long-term norfloxacin therapy in patients with advanced cirrhosis[J]. Gastroenterology, 2018, 155(6): 1816-1827.e9. DOI: 10.1053/j.gastro.2018.08.026.
[20]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003. 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
[21]	GRANGE JD, AMIOT X. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Gastroenterol Clin Biol, 2000, 24(3): 378-379. https://www.researchgate.net/publication/12451361_Effect_of_intravenous_albumin_on_renal_impairment_and_mortality_in_patients_with_cirrhosis_and_spontaneous_bacterial_peritonitis