Rahimi Robert S, Rockey Don C
Division of Hepatology, Department of Internal Medicine, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
Semin Liver Dis. 2016 Feb;36(1):48-55. doi: 10.1055/s-0036-1571298. Epub 2016 Feb 12.
Hepatic encephalopathy (HE) is a major complication in patients with decompensated cirrhosis, leading to higher readmission rates causing a profound burden of disease and considerable health care costs. Because ammonia is thought to play a crucial role in the pathogenesis of HE, therapies directed at reducing ammonia levels are now being aggressively developed. Ammonia scavengers such as AST-120 (spherical carbon adsorbent), glycerol phenylbutyrate, sodium phenylacetate or sodium benzoate, and ornithine phenylacetate have been used to improve HE symptoms. A new approach, bowel cleansing with polyethylene glycol 3350, appears to be a promising therapy, with a recent study demonstrating a more rapid improvement in overt HE (at 24 hours after treatment) than lactulose. Extracorporeal devices, although now used primarily in research settings, have also been utilized in patients with refractory HE, but are not approved for clinical management.
肝性脑病（HE）是失代偿期肝硬化患者的主要并发症，导致更高的再入院率，造成沉重的疾病负担和可观的医疗费用。由于氨被认为在HE的发病机制中起关键作用，目前正在积极研发旨在降低氨水平的治疗方法。氨清除剂，如AST-120（球形碳吸附剂）、苯丁酸钠甘油酯、苯乙酸钠或苯甲酸钠以及鸟氨酸苯乙酸，已被用于改善HE症状。一种新的方法，即使用聚乙二醇3350进行肠道清洁，似乎是一种有前景的治疗方法，最近一项研究表明，与乳果糖相比，该方法能使显性HE（治疗后24小时）更快得到改善。体外装置虽然目前主要用于研究，但也已用于难治性HE患者，不过尚未获批用于临床治疗。
