Patel D, McPhail M J W, Cobbold J F L, Taylor-Robinson S D
Department of Medicine, Hepatology and Gastroenterology Section, Imperial College London, St Mary's Hospital Campus, London.
Br J Hosp Med (Lond). 2012 Feb;73(2):79-85. doi: 10.12968/hmed.2012.73.2.79.
Hepatic encephalopathy is a serious and potentially fatal complication of both acute and chronic liver disease, arising as a result of hepatocellular failure, cirrhosis and/or portal-systemic shunting (Ferenci et al, 2002). It reflects a broad spectrum of neuropsychiatric abnormalities, encompassing a range of defects in psychomotor, locomotive, cognitive, emotional and behavioural functions (Prakash and Mullen, 2010). Hepatic encephalopathy is either overt or minimal. While overt hepatic encephalopathy can be diagnosed using bedside clinical tests, minimal hepatic encephalopathy is clinically invisible and requires psychometric testing to diagnose. The rising prevalence of end-stage viral hepatitis-related liver disease, coupled with the growing problem of alcoholic and non-alcoholic fatty liver disease, has significantly increased the burden of disease from cirrhosis (Mooney et al, 2007; Fleming et al, 2008), so recognition and appropriate management of the manifestations of decompensating cirrhosis (including hepatic encephalopathy) is essential. Hepatic encephalopathy has a substantial societal burden because of its impact on survival, quality of life and daily functioning, including an impaired ability to drive, leaving patients especially vulnerable to road traffic accidents (Ferenci et al, 2002; Prakash and Mullen, 2010).
肝性脑病是急慢性肝病的一种严重且可能致命的并发症，由肝细胞衰竭、肝硬化和/或门体分流引起（费伦奇等人，2002年）。它反映了广泛的神经精神异常，包括一系列精神运动、运动、认知、情感和行为功能缺陷（普拉卡什和马伦，2010年）。肝性脑病分为显性和轻微型。虽然显性肝性脑病可通过床边临床检查诊断，但轻微肝性脑病在临床上不可见，需要进行心理测量测试来诊断。终末期病毒性肝炎相关肝病的患病率不断上升，再加上酒精性和非酒精性脂肪性肝病问题日益严重，显著增加了肝硬化的疾病负担（穆尼等人，2007年；弗莱明等人，2008年），因此识别和妥善处理失代偿期肝硬化的表现（包括肝性脑病）至关重要。肝性脑病对生存、生活质量和日常功能有影响，包括驾驶能力受损，使患者特别容易发生道路交通事故，因此具有重大的社会负担（费伦奇等人，2002年；普拉卡什和马伦，2010年）。
