重症肝病合并侵袭性真菌感染诊治专家共识

中华肝脏病杂志2022年2月第30卷第2期Chin J Hepatol,.February2022,Vol.30,No.2·159指南与共识·重症肝病合并侵袭性真菌感染诊治专家共识中国研究型医院学会肝病专业委员会重症肝病学组中华医学会肝病学分会重型肝病与人工肝学组通信作者：胡瑾华，解放军总医院第五医学中心肝病医学部，北京100039，Emil:13910020608@163.com;韩涛，南开大学人民医院，天津300121，Email:hantaomd(@126.com【摘要】重症肝病合并侵袋性真菌感染(F)预后差，临床表现常不典型，而抗真菌药物又多在肝脏代谢，毒副作用大，临床诊治困难。中国研究型医院学会肝病专业委员会和中华医学会肝病学分会组织相关专家，根据重症肝病忠者的特点，形成专家共识，以供医务人员在制定重症肝病合并IFI诊治决策时参考。【关键词】重症肝病，侵袭性真菌感染：诊断：防治：共识D0I:10.3760/ama.j.am501113-20220130-00053Consensus on diagnosis and treatment of invasive fungal infection in patients with severe liver diseaseSevereLiver Disease Group,the Professional Committee for Hepatology.Chinese Research Hospital Association:SevereLiver Disease and Artificial Liver Group.Chinese Society of Hepatology.Chinese Medical AssociationCorresponding author:Hu Jinhua.Senior Department of Hepatology.the Fifth Medical Center of PLA GeneralHospital,Beijing 100039.China,Email:13910020608@163.comCo-corresponding author:Han Tao,Tianjin Union Medicine Center,Nankai University Affiliated Hospital,Tianjin 300121,China,Email:hantaomd@126.com1915[Abstract]The prognosis of severe liver disease combined with invasive fungal infection(IFD)is poor,and the clinical manifestations are often atypical.Moreover,most of the antifungal drugs are metabolized in theliver.with severe toxicities and side effects.making clinical diagnosis and treatment difficult.The ProfessionalCommittee for Hepatology,the Chinese Research Hospital Association and the Hepatology Branch of ChinaMedical Association organized relevant experts to formulate an expert consensus based on the characteristicsof patients with severe liver disease combined with IFI,in order to provide reference for medical personnel inmaking decisions on the diagnosis and treatment.IKey words]Severe liver disease:Invasive fungal infection;Diagnosis;Prevention;ConsensusD0I:10.3760/ama.j.am501113-20220130-00053侵袭性真菌感染(invasive fungal infection,IFI),是表1推荐意见的证据等级和推荐强度指侵犯至人体深部组织器官的真菌感染，导致组织损害、器级别说明官功能障碍和炎症反应等病理改变及病理生理过程，是重症证据等级肝病患者的严重并发症之一。重症肝病合并预后差，病高质量(A)进一步研究也不可能改变该疗效评估结果的可信度中等质量(B)进一步研究很可能彭响该疗效评估结果的可信度死率高，临床表现常不典型，而抗真菌药物又多在肝脏代谢，低质量(C)进一步研究极有可能影响该宁效评估结果的可信度毒副作用大，临床诊治困难。中国研究型医院学会肝病专业推荐等级委员会和中华医学会肝病学分会组织有关专家参考已发表的强推荐(1)显示干预措施利大于弊或者弊大于利相关指南和最新研究进展，根据重症肝病特点，经认真讨论弱推荐(2)显示利弊不确定或无论质量高低的证据均显示利弊相当形成该专家共识，供有关医务人员在制定重症肝病合并FI一、}流行病学诊治决策时参考。重症肝病忠者机体免疫功能严重受损，肠道菌群失调，本共识重症肝病主要包括各种原因导致的失代偿期肝硬包括真菌在内的机会性感染显著增加。随若如糖皮质激素化和肝衰竭，推荐意见参照GRADE评级系统，将证据质量广谱抗菌药物、侵人性操作等诊治手段的应用，重症肝病患分为高(A)、中(B)和低(C)共3级，推荐等级分为强(1).者生存期显著延长，但真菌感染率也呈增高趋势。同时，弱(2)两级（表1）。