Gupta Tarana, Rathi Sahaj, K Dhiman Radha
Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Euroasian J Hepatogastroenterol. 2017 Jan-Jun;7(1):48-54. doi: 10.5005/jp-journals-10018-1211. Epub 2017 May 5.
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination. Presence of poor work productivity, increased accidental injuries on complex machinery and driving, etc., raise the suspicion of cognitive dysfunction. Specialized neurocognitive testing like psychometric HE, computerized tests like critical flicker frequency tests, inhibitory control tests, Stroop encephalopathy tests, and electroencephalography are needed to diagnose overt HE. Various studies have shown lactulose and rifaximin to be useful in overt HE. However, presence of persistent and recurrent HE in cirrhosis is an indication for liver transplant. Lactulose is effective both in improving reversal of minimal HE and in reducing the risk of development of overt HE. Gupta T, Rathi S, Dhiman RK. Managing Encephalopathy in the Outpatient Setting. Euroasian J Hepato-Gastroenterol 2017;7(1):48-54.
在肝硬化中，肝性脑病（HE）对健康相关生活质量有重要影响。明确HE是发作性、复发性还是持续性的；是A型、B型还是C型；是显性HE还是隐性HE；以及是自发性的还是有诱因的，这很重要。显性HE在临床上很明显，需要住院治疗。已证实不可吸收双糖、利福昔明和益生菌对显性HE的治疗有用。隐性HE包括轻微HE和I级HE。在常规临床检查中并不明显。工作效率低下、在操作复杂机械和驾驶时意外伤害增加等情况，会引发对认知功能障碍的怀疑。诊断显性HE需要进行专门的神经认知测试，如心理测量性HE测试、计算机化测试，如临界闪烁频率测试、抑制控制测试、斯特鲁普脑病测试和脑电图检查。各种研究表明乳果糖和利福昔明对显性HE有用。然而，肝硬化中持续性和复发性HE的存在是肝移植的指征。乳果糖在改善轻微HE的逆转以及降低显性HE发生风险方面均有效。古普塔T、拉蒂S、迪曼RK。门诊环境中肝性脑病的管理。《欧亚肝脏胃肠病学杂志》2017年；7(1):48 - 54。
