Bajaj Jasmohan S
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23221, USA.
Expert Rev Gastroenterol Hepatol. 2008 Dec;2(6):785-90. doi: 10.1586/17474124.2.6.785.
Minimal hepatic encephalopathy (MHE) is a neurocognitive dysfunction that is present in the majority of patients with cirrhosis. MHE has a characteristic cognitive profile that cannot be diagnosed clinically. This cognitive dysfunction is independent of sleep dysfunction or problems with overall intelligence. MHE has a significant impact on quality of life, the ability to function in daily life and progression to overt hepatic encephalopathy. Driving ability can be impaired in MHE and this may be a significant factor behind motor vehicle accidents. A crucial aspect of the clinical care of MHE patients is their driving history, which is often ignored during routine care and can add a vital dimension to the overall disease assessment. Driving history should be an integral part of the care of patients with MHE. The preserved communication skills and lack of specific signs and insight make MHE difficult to diagnose. The predominant strategies for MHE diagnosis are psychometric or neurophysiological testing. These are usually limited by financial, normative or time constraints. Studies into inhibitory control, cognitive drug research and critical flicker frequency tests are encouraging. These tests do not require a psychologist for administration and interpretation. Lactulose and probiotics have been studied for their potential use as therapies for MHE, but these are not standard-of-care practices at this time. Therapy can improve the quality of life in MHE patients but the natural history, specific diagnostic strategies and treatment options are still being investigated.
轻微肝性脑病（MHE）是一种神经认知功能障碍，存在于大多数肝硬化患者中。MHE具有一种临床无法诊断的特征性认知模式。这种认知功能障碍独立于睡眠功能障碍或整体智力问题。MHE对生活质量、日常生活功能以及进展为显性肝性脑病均有重大影响。MHE患者的驾驶能力可能受损，这可能是机动车事故背后的一个重要因素。MHE患者临床护理的一个关键方面是他们的驾驶史，而这在常规护理中常常被忽视，并且可为整体疾病评估增添至关重要的维度。驾驶史应成为MHE患者护理的一个组成部分。MHE患者保留的沟通能力以及缺乏特定体征和自知力使得其难以诊断。MHE诊断的主要策略是心理测量或神经生理学测试。这些测试通常受到资金、规范性或时间限制。对抑制控制、认知药物研究和临界闪烁频率测试的研究令人鼓舞。这些测试不需要心理学家进行管理和解读。乳果糖和益生菌已被研究其作为MHE治疗方法的潜在用途，但目前这些并非标准治疗方法。治疗可改善MHE患者的生活质量，但自然病程、具体诊断策略和治疗选择仍在研究中。
