Dept. Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium; Inserm Unité 1149, Centre de Recherche sur l'inflammation (CRI), Paris, France; UMR S_1149, Université Paris Diderot, Paris, France; The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain.
The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; Liver Unit, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain; CIBEREHED, Barcelona, Spain.
J Hepatol. 2017 Nov;67(5):1031-1050. doi: 10.1016/j.jhep.2017.06.013. Epub 2017 Jun 22.
Alcohol-related liver disease (ALD) remains the most important cause of death due to alcohol. Infections, particularly bacterial infections, are one of the most frequent and severe complications of advanced ALDs, such as alcoholic cirrhosis and severe alcoholic hepatitis (sAH). The specific mechanisms responsible for this altered host defence are yet to be deciphered. The aim of the present study is to review the current knowledge of infectious complications in ALD and its pathophysiological mechanisms, distinguishing the role of alcohol consumption and the contribution of different forms of ALD. To date, corticosteroids are the only treatment with proven efficacy in sAH, but their impact on the occurrence of infections remains controversial. The combination of an altered host defence and corticosteroid treatment in sAH has been suggested as a cause of opportunistic fungal and viral infections. A high level of suspicion with systematic screening and prompt, adequate treatment are warranted to improve outcomes in these patients. Prophylactic or preemptive strategies in this high-risk population might be a preferable option, because of the high short-term mortality rate despite adequate therapies. However, these strategies should be assessed in well-designed trials before clinical implementation.
酒精性肝病（ALD）仍然是由于酒精导致的最重要的死亡原因。感染，特别是细菌感染，是晚期 ALD 的最常见和最严重的并发症之一，如酒精性肝硬化和严重酒精性肝炎（sAH）。导致这种宿主防御改变的具体机制仍有待破译。本研究旨在综述 ALD 感染并发症及其病理生理机制的现有知识，区分酒精摄入的作用和不同形式的 ALD 的贡献。迄今为止，皮质类固醇是唯一被证明对 sAH 有效的治疗方法，但它们对感染发生的影响仍存在争议。sAH 中宿主防御改变和皮质类固醇治疗的结合被认为是机会性真菌感染和病毒感染的原因。需要高度怀疑并进行系统筛查，并及时、充分治疗，以改善这些患者的预后。在这种高风险人群中，预防性或先发制人的策略可能是一个更好的选择，因为尽管有适当的治疗，但短期死亡率仍然很高。然而，在临床实施之前，这些策略应该在精心设计的试验中进行评估。
