Department of Gastroenterology, G.B.Pant Hospital, Academic Block Room - 203, New Delhi, India.
Metab Brain Dis. 2013 Jun;28(2):313-20. doi: 10.1007/s11011-013-9392-4. Epub 2013 Mar 2.
Management of hepatic encephalopathy (HE) primarily involves avoidance of precipitating factors and administration of various ammonia-lowering therapies such as nonabsorbable disaccharides and antimicrobial agents like rifaximin. The nonabsorbable disaccharides which include lactulose and lactitol are considered the first-line therapy for the treatment of HE and minimal hepatic encephalopathy (MHE). Lactulose significantly improves cognitive function and health-related quality of life in patients with MHE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects. Lactulose has also shown to be effective in primary and secondary prophylaxis of HE. Disaccharides were found to be comparable to rifaximin in recent systemic reviews in the treatment of HE however conclusion was based on inclusion of some poor quality trials. Combination therapy of disaccharides either with rifaximin, L-ornithine L-aspartate,probiotics for the treatment of HE needs further validation in large studies.
肝性脑病（HE）的治疗主要包括避免诱发因素和使用各种降低血氨的治疗方法，如不吸收的双糖和利福昔明等抗菌药物。不吸收的双糖包括乳果糖和乳山梨醇，被认为是治疗 HE 和轻微肝性脑病（MHE）的一线治疗方法。乳果糖可显著改善 MHE 患者的认知功能和健康相关生活质量。乳山梨醇在治疗 HE 方面与乳果糖相当，副作用更少。乳果糖在预防 HE 的一级和二级预防中也显示出有效。在最近的系统性综述中，双糖在治疗 HE 方面与利福昔明相当，然而这一结论是基于纳入了一些质量较差的试验。双糖联合利福昔明、L-鸟氨酸 L-天冬氨酸、益生菌治疗 HE 需要在大型研究中进一步验证。
