慢加急性肝衰竭合并感染的研究进展

卞佳乐; 韩涛

doi:10.12449/JCH260802

慢加急性肝衰竭合并感染的研究进展

DOI: 10.12449/JCH260802

卞佳乐,
韩涛^, ,

南开大学第一附属医院/天津市人民医院消化（肝病）科，天津 300121

基金项目:

国家自然科学基金 (82470660);

国家自然科学基金 (82170630)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：卞佳乐负责文献收集，起草撰写论文；韩涛负责设计论文框架，拟定写作思路，指导文章撰写、修改并定稿。

详细信息

通信作者:
韩涛， hantaomd@126.com （ORCID： 0000-0003-4216-6968）

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出版历程
- 收稿日期: 2026-05-06
- 录用日期: 2026-07-24
- 出版日期: 2026-08-25

Research advances in acute-on-chronic liver failure with infection

Jiale Bian,
Tao Han^{,
,}

Department of Gastroenterology and Hepatology，The First Affiliated Hospital of Nankai University/Tianjin People’s Hospital，Tianjin 300121，China

Research funding:

National Natural Science Foundation of China (82470660);

National Natural Science Foundation of China (82170630)

More Information

Corresponding author: Han Tao， hantaomd@126.com （ORCID： 0000-0003-4216-6968）

摘要

摘要: 感染既是慢加急性肝衰竭的常见诱因，也是其重要的并发症，与患者多器官功能衰竭及高病死率密切相关。本文围绕慢加急性肝衰竭合并感染的流行病学、临床与病原学特征、发病机制以及诊断和治疗策略的新进展进行系统综述，旨在为进一步优化此类患者的临床决策、探索新型诊治方法提供参考。
- 慢加急性肝功能衰竭 /
- 感染 /
- 诊断 /
- 治疗学
Abstract: Infection is not only a common predisposing factor for acute-on-chronic liver failure （ACLF）， but also a critical complication of ACLF， and it is closely associated with multiple organ failure and high mortality. This article systematically reviews the recent advances in the epidemiology， clinical and etiological features， pathogenesis， and diagnosis and treatment strategies of ACLF with infection， in order to provide guidance for further optimizing clinical decision-making and exploring novel diagnostic and treatment methods for such patients.
- Acute-On-Chronic Liver Failure /
- Infections /
- Diagnosis /
- Therapeutics

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表 1 慢加急性肝衰竭合并感染的诊断指标与方法

Table 1. Diagnostic indicators and methods for acute-on-chronic liver failure complicated by infection

类型	指标或技术	临床应用情况
经典指标
细菌感染	C反应蛋白、降钙素原、白细胞计数及中性粒细胞比例等	常规应用
细菌感染	血液、腹水、尿液、痰液等病原学培养及药敏试验	常规应用
真菌感染	G试验、GM试验、隐球菌荚膜多糖抗原、涂片镜检、染色和组织病理检查、分子生物学诊断技术等	常规应用
新型标志物	可溶性CD14亚型^［38］、sTREM-1^［38］、sPD-L1^［35］、IL-1RA^［36］、PGE₂^［20］、IL-6^［39］、BTLA^［23］等	探索阶段
多指标联合模型	IL-1RA联合模型^［36］、GIC模型^［39］、WBD模型^［40］、整合蛋白质组学与临床变量联合模型^［34］等	探索阶段
其他新型技术	mNGS^［37］等	选择性应用
	MALDI-TOF MS	选择性应用
	多组学整合技术	探索阶段
注：G试验，1，3-β-D-葡聚糖试验；GM试验，曲霉半乳甘露聚糖试验；sTREM-1，可溶性髓系细胞触发受体1；sPD-L1，可溶性程序性死亡受体配体1；PGE₂，前列腺素E₂；IL-6，白细胞介素6；BTLA，B细胞和T细胞衰减因子；IL-1RA，白细胞介素1受体拮抗剂；GIC模型，球蛋白-白细胞介素6-C反应蛋白模型；WBD模型，白细胞计数-血尿素氮-D-二聚体模型；mNGS，宏基因组二代测序；MALDI-TOF MS，基质辅助激光解析电离-飞行时间质谱。

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