Division of Gastroenterology/Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Gastroenterol Hepatol. 2011 Sep;9(9):727-38. doi: 10.1016/j.cgh.2011.02.031. Epub 2011 Mar 11.
Patients with cirrhosis are immunocompromised and susceptible to infections. Although detection and treatment of spontaneous bacterial peritonitis (SBP) have improved, overall survival rates have not increased greatly in recent decades-infection still increases mortality 4-fold among patients with cirrhosis. Hospitalized patients with cirrhosis have the highest risk of developing infections, especially patients with gastrointestinal (GI) hemorrhage. Bacterial infections occur in 32% to 34% of patients with cirrhosis who are admitted to the hospital and 45% of patients with GI hemorrhage. These rates are much higher than the overall rate of infection in hospitalized patients (5%-7%). The most common are SBP (25% of infections), urinary tract infection (20%), and pneumonia (15%). Bacterial overgrowth and translocation from the GI tract are important steps in the pathogenesis of SBP and bacteremia-these processes increase levels of endotoxins and cytokines that induce the inflammatory response and can lead to septic shock, multiorgan dysfunction, and death. A number of other bacterial and fungal pathogens are more common and virulent in patients with cirrhosis than in the overall population. We review the pathogenesis of infections in these patients, along with diagnostic and management strategies.
肝硬化患者的免疫功能受损，易发生感染。尽管自发性细菌性腹膜炎 (SBP) 的检测和治疗有所改善，但近几十年来总体生存率并未大幅提高——感染仍然使肝硬化患者的死亡率增加了 4 倍。住院的肝硬化患者发生感染的风险最高，尤其是有胃肠道 (GI) 出血的患者。住院的肝硬化患者中有 32%至 34%发生细菌感染，有 GI 出血的患者中有 45%发生细菌感染。这些比率远高于住院患者的总体感染率（5%-7%）。最常见的是 SBP（感染的 25%）、尿路感染（20%）和肺炎（15%）。细菌过度生长和从胃肠道易位是 SBP 和菌血症发病机制中的重要步骤——这些过程会增加内毒素和细胞因子的水平，从而引发炎症反应，并可能导致感染性休克、多器官功能障碍和死亡。一些其他细菌和真菌病原体在肝硬化患者中比在普通人群中更为常见且具有更强的毒性。我们回顾了这些患者感染的发病机制，以及诊断和治疗策略。
