慢加急性肝衰竭合并侵袭性真菌感染的 诊治进展
Progress in the Diagnosis and Treatment of Acute-on-Chronic Liver Failure Complicated with Invasive Fungal Infection
摘要: 慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)是慢性肝病基础上出现的急性失代偿综合征，以多器官功能衰竭和高死亡率为特征。侵袭性真菌感染(invasive fungal infection, IFI)是ACLF患者常见且严重的并发症，因其临床表现不典型、诊断困难，且治疗受肝功能影响而极具挑战。本文系统综述ACLF患者合并IFI的流行病学特征、诊断难点及治疗策略最新进展。重点探讨抗真菌药物的个体化选择(包括三唑类药物、棘白菌素类及新型药物)、治疗药物监测(therapeutic drug monitoring, TDM)的应用、抢先治疗与靶向治疗策略的优化，以及综合管理的重要性。此外，本文还介绍了宏基因组二代测序(mNGS)等新型诊断技术的应用，以及经验性抗真菌治疗的最新循证医学证据。通过对现有证据的梳理，旨在为临床工作者提供切实可行的诊疗思路，最终改善这一危重人群的预后。
Abstract: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation in patients with pre-existing chronic liver disease, associated with multi-organ failure and high mortality. Invasive fungal infection (IFI) represents a common and severe complication in patients with ACLF. Its management is particularly challenging due to atypical clinical presentations, diagnostic difficulties, and the impact of hepatic impairment on antifungal therapy. This article systematically reviews the latest advances in the epidemiology, diagnostic challenges, and treatment strategies for IFI in patients with ACLF. It focuses on the individualized selection of antifungal agents (including triazoles, echinocandins, and novel drugs), the application of therapeutic drug monitoring (TDM), the optimization of pre-emptive versus targeted therapeutic strategies, and the importance of comprehensive management. Furthermore, this review introduces the application of novel diagnostic technologies, such as metagenomic next-generation sequencing (mNGS), and the latest evidence-based medical evidence for empirical antifungal therapy. By synthesizing the current evidence, this review aims to provide clinicians with practical diagnostic and therapeutic approaches to ultimately improve the prognosis of this critically ill patient population.
文章引用：周晓琪, 李世颖. 慢加急性肝衰竭合并侵袭性真菌感染的 诊治进展[J]. 临床医学进展, 2026, 16(4): 33-42. https://doi.org/10.12677/acm.2026.1641222

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