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山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (2): 1-8.doi: 10.6040/j.issn.1671-7554.0.2017.562

• 专家述评 •    

肝性脑病诊断及治疗进展

张纵,王晓花   

  1. 济南市传染病医院肝病科, 山东 济南 250021
  • 发布日期:2022-09-28
  • 通讯作者: 王晓花. E-mail: wangxiaoh5923_cn@126.com

Advances in the diagnosis and treatment of hepatic encephalopathy

ZHANG Zong, WANG Xiaohua   

  1. Department of Liver Disease, Jinan Infectious Diseases Hospital, Jinan 250021, Shandong, China
  • Published:2022-09-28

摘要: 肝性脑病(HE)是一种由于肝功能严重障碍和/或门静脉-体循环分流异常所导致的脑功能障碍,表现为从亚临床改变到昏迷的程度不等的一系列神经精神异常综合征。HE严重威胁患者的生命健康。本文对轻微型肝性脑病的诊断方法和显性肝性脑病的治疗进展进行了简要综述。

关键词: 肝性脑病, 乳果糖, 利福昔明, 轻微型肝性脑病, 显性肝性脑病

Abstract: Hepatic encephalopathy(HE)was defined as brain dysfunction resulting from liver insufficiency and/or portosystemic shunting, with different degree of neurological and psychiatric abnormalities syndrome, ranging from subclinical change to even coma. HE endangered the health and life of patients. This article briefly reviewed the latest advances in the diagnostic methods of minimal hepatic encephalopathy(MHE)and management of overt hepatic encephalopathy(OHE).

Key words: Hepatic encephalopathy, Lactulose, Rifaximin, Minimal hepatic encephalopathy, Overt hepatic encephalopathy

中图分类号: 

  • R575.3
[1] Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60(2):715-735.
[2] Romero-Gómez M, Boza F, García-Valdecasas MS, et al. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2001, 96(9): 2718-2723.
[3] Stinton LM, Jayakumar S. Minimal hepatic encephalopathy[J]. Can J Gastroenterol, 2013, 27(10): 572-574.
[4] DAmico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies[J]. J Hepatol, 2006, 44(1): 217-231.
[5] Rahimi RS, Elliott AC, Rockey DC. Altered mental status in cirrhosis: etiologies and outcomes[J]. J Investig Med, 2013, 61(4):695-700.
[6] Ferenci P, Lockwood A, Mullen K, et al. Hepatic encephalopathy- definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998[J]. Hepatology, 2002, 35(3): 716-721.
[7] Bleibel W, Al-Osaimi AM. Hepatic encephalopathy[J]. Saudi J Gastroenterol, 2012, 18(5): 301-309.
[8] 叶青, 荣琳, 汪心婷, 等. 肝性脑病大鼠肝及脑组织蛋白质硝基化和细胞凋亡的研究[J]. 山东大学学报(医学版), 2010, 48(8): 38-41. YE Qing, RONG Lin, WANG Xinting, et al. Protein nitrotyrosine and cell apoptosis in the liver and brain of hepatic encephalopathy rats[J]. Journal of Shandong University(Health Sciences), 2010, 48(8): 38-41.
[9] Cash WJ, McConville P, McDermott E, et al. Current concepts in the assessment and treatment of hepatic encephalopathy[J]. QJM, 2010, 103(1): 9-16.
[10] Bismuth M, Funakoshi N, Cadranel JF, et al. Hepatic encephalopathy: from pathophysiology to therapeutic management[J]. Eur J Gastroenterol Hepatol, 2011, 23(1): 8-22.
[11] 中华医学会消化病学分会,中华医学会肝病学分会. 中国肝性脑病诊治共识意见(2013 年, 重庆)[J]. 中华肝脏病杂志, 2013, 21(9): 641-651. Chinese Society of Gastroenterology, Chinese Society of Hepatology, Chinese Medical Association. Consensus on the diagnosis and treatment of hepatic encephalopathy[J]. Zhonghua Gan Zang Bing Za Zhi, 2013, 21(9): 641-651.
[12] Gupta D, Ingle M, Shah K, et al.Prospective comparative study of inhibitory control test and psychometric hepatic encephalopathy score for diagnosis and prognosis of minimal hepatic encephalopathy in cirrhotic patients in the Indian subcontinent[J]. J Dig Dis, 2015, 16(7): 400-407.
[13] Lauridsen MM, Thiele M, Kimer N, et al. The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy[J]. Metab Brain Dis, 2013, 28(2): 231-234.
[14] Lauridsen MM, Schaffalitzky de Muckadell OB, Vilstrup H. Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests[J]. Metab Brain Dis, 2015, 30(5): 1187-1192.
[15] Bajaj JS, Thacker LR, Heumann DM, et al. The stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy[J]. Hepatology, 2013, 58(3): 1122-1132.
[16] Bajaj JS, Heuman DM, Sterling RK, et al. Validation of encephalApp, smartphone-based stroop test, for the diagnosis of covert hepatic encephalopathy[J]. Clin Gastroenterol Hepatol, 2015, 13(10): 1828-1835.
[17] Amodio P, Del Piccolo F, Marchetti P, et al. Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests[J]. Hepatology, 1999, 29(6): 1662-1667.
[18] Ampuero J, Simón M, Montoliú C, et al. Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis[J]. Gastroenterology, 2015, 149(6): 1483-1489.
[19] Torlot FJ, McPhail MJ, Taylor-Robinson SD. Meta-analysis: The diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy[J]. Aliment Pharmacol Ther, 2013, 37(5): 527-536.
[20] Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy[J]. Gastroenterology, 2014, 146(4): 961-969.
[21] Montagnese S, De Rui M, Schiff S, et al. Prognostic benefit of the addition of a quantitative index of hepatic encephalopathy to the MELD score: the MELD-EEG[J]. Liver Int, 2015, 35(1): 58-64.
[22] Campagna F, Montagnese S, Schiff S, et al. Confounders in the detection of minimal hepatic encephalopathy: a neuropsychological and quantified EEG study[J]. Liver Int, 2015, 35(5): 1524-1532.
[23] Ciecko-Michalska I, Wojcik J, Wyczesany M, et al. Cognitive evoked response potentials in patients with liver cirrhosis without diagnosis of minimal or overt hepatic encephalopathy. A pilot study[J]. J Physiol Pharmacol, 2012, 63(3): 271-276.
[24] Meng LP, Chen YC, Ii YH, et al. Viability assessment of magnetic resonance spectroscopy for the detection of minimal hepatic encephalopathy severity[J]. Eur J Radiol, 2015, 84(10): 2019-2023.
[25] Felipo V, Urios A, Giménez-Garzó C, et al. Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests[J]. World J Gastroenterol, 2014, 20(33): 11815-11825.
[26] Lockwood AH. Blood ammonia levels and hepatic encephalopathy[J]. Metab Brain Dis, 2004, 19(3-4): 345-349.
[27] Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy[J]. N Engl J Med, 2010, 362(12): 1071-1081.
[28] Bajaj JS, Heuman DM, Sanyal AJ, et al. Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy[J]. PLoS One, 2013, 8(4): e60042. doi: 10.1371/journal.pone.0060042.
[29] Bajaj JS, Heuman DM, Wade JB, et al. Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy[J]. Gastroenterology, 2011, 140(2): 478-487.
[30] Sidhu SS, Goyal O, Mishra BP, et al. Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy(the RIME Trial)[J]. Am J Gastroenterol, 2011, 106(2): 307-316.
[31] Schulz C, Schütte K, Kropf S, et al. RiMINI-the influence of rifaximin on minimal hepatic encephalopathy(MHE)and on the intestinal microbiome in patients with liver cirrhosis: study protocol for a randomized controlled trial[J]. Trials, 2016, 29: 17(1): 111. doi: 10.1186/s13063-016-1205-8.
[32] Alvares-da-Silva MR, de Araujo A, Vicenzi JR, et al. Oral l-ornithine-laspartate in minimal hepatic encephalopathy: A randomized, double-blind, placebo-controlled trial[J]. Hepatol Res, 2014, 44(9): 956-963.
[33] Malaguarnera M, Bella R, Vacante M, et al. Acetyl-L-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy[J]. Scand J Gastroenterol, 2011, 46(6): 750-759.
[34] Merli M, Giusto M, Lucidi C, et al. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study[J]. Metab Brain Dis, 2013, 28(2): 281-284.
[35] Gluud LL, Dam G, Borre M, et al. Oral branched-chain amino acids have a beneficial effect on manifestations of hepatic encephalopathy in a systematic review with meta-analyses of randomized controlled trials[J]. J Nutr, 2013, 143(8): 1263-1268.
[36] Amodio P, Bemeur C, Butterworth R, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J]. Hepatology, 2013, 58(1): 325-336.
[37] Chavez-Tapia NC, Cesar-Arce A, Barrientos-Gutierrez T, et al. A systematic review and meta- analysis of the use of oral zinc in the treatment of hepatic encephalopathy[J]. Nutr J, 2013, 12: 74. doi: 10.1186/1475-2891-12-74.
[38] Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials[J]. BMJ, 2004, 328(7447): 1046.
[39] Gluud LL, Vilstrup H, Morgan MY. Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta-analysis[J]. Hepatology, 2016, 64(3): 908-922.
[40] DuPont HL. Rifaximin: an antibiotic with important biologic effects[J]. Mini Rev Med Chem, 2015, 16(3): 200-205.
[41] Sharma BC, Sharma P, Lunia MK, et al. A randomized, double blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2013, 108(9): 1458-1463.
[42] Aires FT, Ramos PT, Bernardo WM. Efficacy of lactulose in the prophylaxis of hepatic encephalopathy in cirrhotic patients presenting gastrointestinal bleeding[J]. Rev Assoc Med Bras, 2016, 62(3): 243-247.
[43] Leise MD, Poterucha JJ, Kamath PS, et al. Management of hepatic encephalopathy in the hospital[J]. Mayo Clin Proc, 2014, 89(2): 241-253.
[44] Bai M, Yang Z, Qi X, et al. I-ornithine-I-aspartate for hepatic encephalopathy in patients with cirrhosis: a meta-analysis of randomized controlled trials[J]. J Gastroenterol Hepatol, 2013, 28(5): 783-792.
[45] Misel ML, Gish RG, Patton H, et al. Sodium benzoate for treatment of hepatic encephalopathy[J]. Gastroenterol Hepatol(NY), 2013, 9(4): 219-227.
[46] Rockey DC, Vierling JM, Mantry P, et al. Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy[J]. Hepatology, 2014, 59(3): 1073-1083.
[47] Gluud LL, Dam G, Les I, et al. Branched-chain amino acids for people with hepatic encephalopathy[J]. Cochrane Database Syst Rev. 2017, 5: CD001939. doi: 10.1002/14651858.CD001939.pub4.
[48] Vergara M, Castro-Gutiérrez V, Rada G. Do branched chain amino acids improve hepatic encephalopathy in cirrhosis?[J] Medwave, 2016, 16(Suppl5): e6795. doi: 10.5867/medwave.2016.6795.
[49] McGee RG, Bakens A, Wiley K, et al. Probiotics for patients with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2011, 11: CD008716. doi: 10.1002/14651858.CD008716.
[50] Holte K, Krag A, Gluud LL. Systematic review and meta-analysis of randomized trials on probiotics for hepatic encephalopathy[J]. Hepatol Res, 2012, 42(10): 1008-1015.
[51] Saab S, Suraweera D, Au J, et al. Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials[J]. Liver Int, 2016, 36(7): 986-993.
[52] Dalal R, McGee RG, Riordan SM, et al. Probiotics for people with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2017, 2: CD008716. doi: 10.1002/14651858
[53] Valdovinos MA, Montijo E, Abreu AT, et al. The Mexican consensus on probiotics in gastroenterology[J]. Rev Gastroenterol Mex, 2017, 82(2): 156-178.
[54] Sharma BC, Singh J. Probiotics in management of hepatic encephalopathy[J]. Metab Brain Dis, 2016, 31(6): 1295-1301.
[55] Laleman W, Simon-Talero M, Maleux G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy[J]. Hepatology, 2013, 57(6): 2448-2457.
[56] An J, Kim KW, Han S, et al. Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy[J]. Aliment Pharmacol Ther, 2014, 39(12): 1418-1426.
[57] Banares R, Nevens F, Larsen FS, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial[J]. Hepatology, 2013, 57(3): 1153-1162.
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