肝脏疾病对药物代谢动力学有难以预料的影响,而人们对抗菌药物在这方面却很少有详细的研究;肝病患者使用抗菌药的总原则也是从其它药物借鉴的。肝病患者应用药物时出现较多副作用的机理并不完全清楚。例如氨基糖苷类抗生素,虽然几乎完全从肾脏排泄,但其肾毒性似乎可通过肝脏疾病而被加重。肝病能通过多种途径影响药物代谢,如改变肝廓清率,降低肝代谢能力,或由于门脉高压绕过肝脏,减少血清中与蛋白结合的药物浓度,改变药物与蛋白的亲和力以及改变药物自胃肠道的吸收等。一般说来,肝脏代谢药物的能力相当强,只是在严重肝病时这种能力才受影响,但也有报道急性肝 Liver diseases have unpredictable effects on pharmacokinetics. However, there are few studies on antimicrobial drugs in this area. The general principle of antimicrobial use in patients with liver diseases is also borrowed from other drugs. The mechanism of the more side effects of drug use in patients with liver disease is not fully understood. For example, aminoglycoside antibiotics, although almost excreted from the kidneys, appear to be aggravated by liver disease. Liver disease can affect drug metabolism through a variety of pathways, such as altering the clearance rate of liver, reducing hepatic metabolism, bypassing the liver due to portal hypertension, reducing the concentration of drug bound to the protein in the serum, altering the affinity of the drug to the protein and altering the drug’s self Gastrointestinal absorption and so on. In general, the ability of the liver to metabolize drugs is quite strong, only in severe liver disease this ability was affected, but there are also reports of acute liver