Laboratorio de Investigación en Hepatología y Gastroenterología, Hospital General Universitario Gregorio Marañón - CIBERehd, Madrid 28009, Spain.
Neurochem Int. 2012 Jun;60(7):723-35. doi: 10.1016/j.neuint.2011.09.006. Epub 2011 Sep 22.
A large body of experimental data and preliminary clinical studies point to the induction of mild hypothermia (32-35 °C) as a valuable approach to control the development of brain edema and intracranial hypertension in acute liver failure (ALF). The ability of hypothermia to affect multiple processes probably explains its efficacy to prevent these cerebral complications. Remarkably, mild hypothermia has been shown to prevent or attenuate most of the major alterations involved in the pathogenesis of the cerebral complications of ALF, including the accumulation of ammonia in the brain and the circulation, the alterations of brain glucose metabolism, the brain osmotic disturbances, the accumulation of glutamate and lactate in brain extracellular space, the development of inflammation and oxidative/nitrosative stress, and others. Limited information suggests that the systemic effects of hypothermia may also be beneficial for some peripheral complications of ALF. Translation of the beneficial effects of therapeutic hypothermia into standard clinical practice, however, needs to be confirmed in adequately designed clinical trials. Such trials will be important to determine the safety of therapeutic hypothermia, to identify which patients might benefit from it, and to provide the optimal guidelines for its use in patients with ALF.
大量的实验数据和初步临床研究表明，诱导轻度低温（32-35°C）是控制急性肝衰竭（ALF）中脑水肿和颅内高压发展的一种有价值的方法。低温能够影响多种过程，这也许可以解释其预防这些脑部并发症的功效。值得注意的是，轻度低温已被证明可以预防或减轻 ALF 脑并发症发病机制中涉及的大多数主要改变，包括脑内和循环中氨的积累、脑葡萄糖代谢的改变、脑渗透失调、谷氨酸和乳酸在脑细胞外间隙的积累、炎症和氧化/硝化应激的发展等。有限的信息表明，低温的全身作用对于 ALF 的一些外周并发症也可能有益。然而，将治疗性低温的有益效果转化为标准临床实践，需要在设计合理的临床试验中得到证实。这些试验对于确定治疗性低温的安全性、确定哪些患者可能从中受益以及为 ALF 患者使用低温提供最佳指南都非常重要。
