Nguyen Douglas L, Morgan Timothy
Gastroenterology Service, VA Long Beach Healthcare System, 11, 5901 E. Seventh Street, Long Beach, CA 90822, USA, Gastroenterology Division, University of California, Irvine, CA, USA.
Hepatol Int. 2014 Sep 1;8(2):447-51. doi: 10.1007/s12072-013-9497-1.
Since the late nineteenth century, protein restriction has been shown to improve hepatic encephalopathy. However, malnutrition has been described in up to 60 % of cirrhotic patients and is associated with increased mortality. Furthermore, emerging clinical evidence has revealed that a large proportion of cirrhotic patients may tolerate normal protein intake. However, approximately one third of cirrhotic patients with hepatic encephalopathy may need a short course of protein restriction, in addition to maximum medical therapy, to ameliorate the clinical course of their hepatic encephalopathy. For patients with chronic hepatic encephalopathy who are protein-sensitive, modifying their sources of nitrogen by using more vegetable protein, less animal protein, and branched-chain amino acids may improve their encephalopathy without further loss of lean body mass. In conclusion, among cirrhotics with hepatic encephalopathy, modulation of normal protein intake must take into account the patient's hepatic reserve, severity of hepatic encephalopathy, and current nutritional status.
自19世纪末以来，蛋白质限制已被证明可改善肝性脑病。然而，高达60%的肝硬化患者存在营养不良，且营养不良与死亡率增加相关。此外，新出现的临床证据表明，很大一部分肝硬化患者可能耐受正常蛋白质摄入。然而，约三分之一的肝硬化合并肝性脑病患者除了接受最大程度的药物治疗外，可能还需要短期的蛋白质限制，以改善其肝性脑病的临床病程。对于对蛋白质敏感的慢性肝性脑病患者，通过增加植物蛋白、减少动物蛋白和使用支链氨基酸来改变氮源，可能改善其脑病，而不会进一步损失瘦体重。总之，在肝硬化合并肝性脑病患者中，调节正常蛋白质摄入必须考虑患者的肝脏储备、肝性脑病的严重程度和当前营养状况。
