Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center (BCD, JSB), Richmond, Virginia.
Alcohol Clin Exp Res. 2018 Apr;42(4):660-667. doi: 10.1111/acer.13605. Epub 2018 Feb 27.
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy (HE). Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as HE. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of HE associated with alcohol use. Acute management of the alcoholic cirrhosis patient with altered mental status should focus on ruling out other causes, best intensive care, and use of gut-based therapies such as lactulose and rifaximin. Long-term management centers on optimizing treatment of concurrent mood disorders, nutritional support, and medical management of complications associated with cirrhosis. Future studies are needed to clarify mechanisms of brain injury in concomitant alcohol misuse and HE in addition to designing treatment interventions in order to improve outcomes in these patients.
近年来的研究进展使人们对酒精如何改变大脑有了更深入的了解，无论是在急性阶段（醉酒和酒精戒断）还是在慢性滥用阶段。本综述重点关注目前对酒精如何影响肝硬化合并和不合并肝性脑病（HE）患者大脑的理解。慢性饮酒与营养缺乏、痴呆、肝硬化以及代偿失调事件（如 HE）有关。酒精对脑组织的直接毒性、神经炎症的诱导以及酒精对肠道微生物组的改变可能是与酒精使用相关的 HE 临床特征的机制。对于精神状态改变的酒精性肝硬化患者的急性治疗应侧重于排除其他原因、提供最佳重症监护，并使用基于肠道的治疗方法，如乳果糖和利福昔明。长期管理的重点是优化治疗并存的情绪障碍、营养支持以及与肝硬化相关并发症的医学管理。需要进一步的研究来阐明酒精滥用和 HE 同时存在时的脑损伤机制，并设计治疗干预措施，以改善这些患者的预后。
