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尽管广泛使用广谱抗生素,但1/4肝病患者仍由于细菌感染而死亡;肝细胞衰竭时,感染所致死亡率达20%。肝病并发感染时,常缺乏临床感染的特征,而以肝昏迷先兆或肾衰的恶化为主,故诊断常有困难。本文综述肝病患者易并发细菌感染诊治方面的一些近展。菌血症 7～20%的肝硬化患者并发菌血症。失代偿性酒精性肝硬化和代偿性肝病时菌血症的死亡率分别为70%与30%,前者的致病菌最多见为革兰氏阴性菌,而后者为革兰氏阳性菌。半数菌血症患者起源于尿道或呼吸道感染;但失代偿性肝硬化时感染常可为自发性。
In spite of the widespread use of broad-spectrum antibiotics, patients with ¼-liver disease are still dead due to bacterial infections; infection-induced mortality in liver failure is up to 20%. Liver disease complicated by infection, often lacking the characteristics of clinical infection, and the deterioration of liver coma or renal failure-based, so the diagnosis is often difficult. This review summarizes some recent advances in the diagnosis and treatment of patients with liver disease complicated with bacterial infections. Bacteremia 7 ~ 20% of patients with cirrhosis complicated by bacteremia. The mortality of bacteremia in decompensated alcoholic cirrhosis and compensated liver disease was 70% and 30%, respectively. The former had the highest incidence of Gram-negative bacteria and the latter Gram-positive bacteria . Half of patients with bacteremia originated in the urethra or respiratory tract infection; but decompensated cirrhosis often spontaneous.