Division of Medicine, UCL Medical School, Royal Free Hospital, UCL Institute for Liver and Digestive Health, Rowland Hill Street, London, NW3 2PF, UK.
Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK.
Hepatol Int. 2018 Feb;12(Suppl 1):135-147. doi: 10.1007/s12072-017-9812-3. Epub 2017 Aug 2.
Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of cirrhosis and/or porto-systemic shunting. The clinical symptoms are widely variable, extending from subtle impairment in mental state to coma. The utility of categorizing the severity of HE accurately and efficiently serves not only to provide practical functional information about the current clinical status of the patient but also gives valuable prognostic information. In the past 20-30 years, there has been rapid progress in understanding the pathophysiological basis of HE; however, the lack of direct correlation between pathogenic factors and the severity of HE make it difficult to select appropriate therapy for HE patients. In this review, we will discuss the classification system and its limitations, the neuropsychometric assessments and their challenges, as well as the present knowledge on the pathophysiological mechanisms. Despite the many prevalent hypotheses around the pathogenesis of the disease, most treatments focus on targeting and lowering the accumulation of ammonia as well as inflammation. However, treatment of minimal HE remains a huge unmet need and a big concerted effort is needed to better define this condition to allow the development of new therapies. We review the currently available therapies and future approaches to treat HE as well as the scientific and clinical data that support their effectiveness.
肝性脑病（HE）是肝硬化和/或门体分流的严重神经精神并发症。临床症状广泛多变，从轻微的精神状态损害到昏迷。准确有效地对 HE 严重程度进行分类不仅有助于提供有关患者当前临床状况的实用功能信息，而且还提供有价值的预后信息。在过去的 20-30 年中，人们对 HE 的病理生理基础有了快速的了解；然而，致病因素与 HE 严重程度之间缺乏直接相关性，使得难以为 HE 患者选择合适的治疗方法。在这篇综述中，我们将讨论分类系统及其局限性、神经心理评估及其挑战，以及目前对病理生理机制的认识。尽管围绕疾病发病机制有许多流行的假说，但大多数治疗方法都集中在靶向和降低氨的积累以及炎症上。然而，治疗轻微肝性脑病仍然是一个巨大的未满足的需求，需要做出巨大的努力来更好地定义这种情况，以便开发新的治疗方法。我们回顾了目前可用的治疗方法和未来治疗 HE 的方法，以及支持其有效性的科学和临床数据。
