鉴于药物在肝脏中的代谢受药代动力学、遗传因素等多方面的影响,致使常用的肝功能试验不能正确地反映病肝对抗菌素的排泄或代谢的能力。氧化代谢中的酶系统对药物代谢起了重要作用,参与药物代谢的酶又可有遗传变异;某些药代动力学因素对抗菌素代谢也有不同的影响。并非肝病患者均属同一种药代动力学类型,在有大量腹水、低蛋白血症和显著黄疸的严重肝硬化患者,其细胞外液量明显增加,因此抗菌素的分布容积也明显增加(如青霉素和氨基甙类)。其次由于低蛋白血症,加上胆红素对结合部位的竞争,不与蛋白结合的抗菌素的浓度也将明显增高。在这种病人,由其他药物所诱发的肝代谢足以清除抗菌 In view of the metabolism of drugs in the liver by the pharmacokinetics, genetic factors and other aspects of the impact, resulting in commonly used liver function tests can not correctly reflect the liver of the antibiotic excretory or metabolic capacity. The enzyme system in oxidative metabolism plays an important role in drug metabolism, and the enzymes involved in drug metabolism can have genetic variation. Some pharmacokinetic factors also have different effects on the metabolism of antibiotics. Not all patients with liver disease are of the same pharmacokinetic type. In patients with severe cirrhosis with large amounts of ascites, hypoalbuminemia, and significant jaundice, the extracellular fluid volume is significantly increased, so the volume of antibiotics is also significantly increased (such as penicillin And aminoglycosides). Second, due to hypoproteinemia, coupled with the competition of bilirubin binding sites, the concentration of antibiotics that do not bind to proteins will also be significantly increased. In such patients, liver metabolism induced by other drugs is sufficient to remove antimicrobials