晚期肝病中的免疫功能紊乱与感染风险

摘要/Abstract

摘要： 晚期肝病,特别是失代偿期肝硬化,与显著的免疫功能紊乱密切相关,这一状态被定义为肝硬化相关免疫功能障碍(CAID)。CAID的核心特征表现为系统性免疫缺陷与慢性全身性炎症并存。免疫缺陷涉及中性粒细胞、巨噬细胞的吞噬趋化功能受损,补体系统合成不足,以及T淋巴细胞耗竭,导致患者对病原体的清除能力严重下降,易发生自发性细菌性腹膜炎、菌血症及真菌感染。同时,由肠道菌群失调、细菌易位触发的持续全身性炎症则驱动肝内及肝外器官损伤的进展。这种双向的免疫失衡共同构成了晚期肝病患者感染风险急剧升高的病理生理基础,并导致其临床预后恶化。本文对CAID的核心机制进行系统阐述,分析了由此带来的细菌、真菌及病毒感染风险特征,并综述了以精准预防、快速诊断和早期目标治疗为核心的临床管理策略。

关键词: 晚期肝病, 免疫功能障碍, 全身性炎症, 细菌感染, 真菌感染, 临床管理

王昊, 毛日成. 晚期肝病中的免疫功能紊乱与感染风险[J]. 肝脏, 2025, 30(10): 1316-1318.

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