Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Paseo Vall d'Hebron 119, Barcelona 08035, Spain.
J Hepatol. 2011 May;54(5):1030-40. doi: 10.1016/j.jhep.2010.11.015. Epub 2010 Dec 5.
Hepatic encephalopathy (HE) is a common complication of cirrhosis that requires careful appraisal of the clinical manifestations, evaluation of the underlying neurological disorders, and assessment of liver function and the portal-systemic circulation. This article reviews recent developments in the assessment of HE and discusses the controversy regarding the use of a categorical or a continuous approach in measuring the severity of this condition. New scales facilitate effective monitoring and assessment of episodic HE. Neuropsychological test batteries and neurophysiological tests are of value for evaluating cognitive function in outpatients and can establish the diagnosis of minimal HE, and the severity of low-grade HE. These tools allow better evaluation of the origin of cognitive complaints and help in estimating the risk of accidents. It is now possible to complete the evaluation with measurement of the effects of cognitive impairment on daily living. In difficult cases, imaging of the brain and portal-systemic circulation with magnetic resonance imaging is especially helpful. Based on these studies, neurological signs and symptoms can be attributed to HE in patients with mild liver disease and in those with complex neurological manifestations. The new methods presented are also valuable for investigating the neurological manifestations occurring after liver transplantation.
肝性脑病（HE）是肝硬化的常见并发症，需要仔细评估其临床表现、评估潜在的神经障碍以及评估肝功能和门体循环。本文综述了 HE 评估的最新进展，并讨论了在衡量该疾病严重程度时使用分类法或连续法的争议。新的量表有助于有效地监测和评估间歇性 HE。神经心理学测试和神经生理学测试对于评估门诊患者的认知功能具有价值，可以确定轻微 HE 和低级别 HE 的严重程度。这些工具可以更好地评估认知障碍的来源，并有助于估计发生事故的风险。现在可以通过测量认知障碍对日常生活的影响来完成评估。在困难的情况下，磁共振成像对大脑和门体循环的成像特别有帮助。基于这些研究，可以将轻度肝病患者和具有复杂神经表现的患者的神经症状归因于 HE。所提出的新方法对于研究肝移植后发生的神经表现也具有重要价值。
