Hepatic decompensation in patients with cirrhosis during infection with influenza A
Hepatic decompensation in patients with cirrhosis during infection with influenza A
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DOI：
10.1001/archinte.160.1.113
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发表时间：
2000-01-10
影响因子：
--
通讯作者：
Pockros, PJ
中科院分区：
文献类型：
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作者：
Duchini, A;Viernes, ME;Pockros, PJ
背景：慢性肝病患者在全身感染时可发生肝功能失代偿。虽然革兰氏阴性菌和革兰氏阳性菌是公认的原因失代偿，流感病毒感染对慢性肝病患者的影响是不好的documented.Methods：回顾性分析的患者病毒培养阳性谁是在肝移植诊所看到在三级护理转诊中心在1997-1998年流感A（H3 N2）流行在圣地亚哥，加利福尼亚州。3例终末期肝病患者（1例威尔逊病和2例酒精性肝病）在感染甲型流感期间发生肝失代偿，需要住院治疗。两名患者有肝失代偿的生化和临床证据，包括腹水、肝性脑病和外周水肿，第三名患者有急性肝细胞损伤，转氨酶水平升高。所有3名患者的病毒性肝炎血清学检测结果、对乙酰氨基酚水平、药物和酒精筛查结果以及细菌和真菌培养均为阴性。肝功能失代偿的解决，而不需要移植的2例肝功能衰竭，所有患者恢复到基线肝功能水平在1个月内发病的急性severity.Conclusions：甲型流感感染可导致肝硬化或等待肝移植的患者肝功能失代偿和住院治疗。强烈建议这些人通过接种疫苗和早期识别和治疗流感进行有效预防。
Background: Patients with chronic liver disease can develop hepatic decompensation during systemic infections. Although gram-negative and gram-positive bacteria are well recognized as causes of decompensation, the effect of influenza virus infection on patients with chronic liver disease is poorly documented.Methods: Retrospective analysis of patients with positive viral cultures who were seen at a liver transplantation clinic in a tertiary care referral center during the 1997-1998 influenza A (H3N2) epidemic in San Diego, Calif.Results: Three patients with end-stage liver disease (1 with Wilson disease and 2 with alcoholic liver disease) developed hepatic decompensation and required hospitalization during infection with influenza A. Two patients had biochemical and clinical evidence of hepatic decompensation, including ascites, hepatic encephalopathy, and peripheral edema, and the third had acute hepatocellular damage, with elevated levels of aminotransferases. Viral hepatitis serologic test results, acetaminophen levels, drug and alcohol screening findings, and bacterial and fungal cultures were negative in all 3 patients. Hepatic decompensation resolved without the need for transplantation in the 2 patients with liver failure, and all patients recovered to their baseline liver function levels within 1 month of onset of acute illness.Conclusions: Influenza A infection can cause hepatic decompensation and hospitalization in patients having cirrhosis or who are awaiting liver transplantation. Effective prevention with vaccination and early recognition and treatment of influenza are strongly recommended in these individuals.