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肝性脑病治疗管理的最新进展

Update on the Therapeutic Management of Hepatic Encephalopathy.

作者信息

Kornerup Linda Skibsted, Gluud Lise Lotte, Vilstrup Hendrik, Dam Gitte

机构信息

Department of Hepatology and Gastroenterology, Aarhus University Hospital, 44 Norrebrogade, 8000, Aarhus, Denmark.

Gastrounit, Medical Division, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, 2650, Denmark.

出版信息

Curr Gastroenterol Rep. 2018 Apr 11;20(5):21. doi: 10.1007/s11894-018-0627-8.

DOI:10.1007/s11894-018-0627-8
PMID:29644492
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5895665/
Abstract

PURPOSE OF REVIEW

Hepatic encephalopathy (HE) is a common and devastating complication to chronic liver disease. In this paper, we summarize the latest research and evidence of both conventional and up-coming treatments.

RECENT FINDINGS

Meta-analyses report beneficial effects of lactulose, branched-chain amino acids, rifaximin, and to some degree L-ornithine L-aspartate on the manifestations of HE in patients with cirrhosis, and generally the numbers needed to treat are low. Recent studies on newer HE treatments including ornithine phenylacetate, spherical carbon, and fecal microbiota transplant also report potentially beneficial effects on HE manifestations. The conventional treatments benefit patients with HE. Newer treatments are under study and more research is needed for their validation.

摘要

综述目的

肝性脑病(HE)是慢性肝病常见且严重的并发症。在本文中,我们总结了传统治疗方法和新兴治疗方法的最新研究及证据。

最新发现

荟萃分析报告了乳果糖、支链氨基酸、利福昔明以及在一定程度上L-鸟氨酸L-天冬氨酸对肝硬化患者HE表现的有益作用,且通常治疗所需人数较少。近期关于包括鸟氨酸苯乙酸、球形碳和粪便微生物群移植等新型HE治疗方法的研究也报告了对HE表现可能有益的作用。传统治疗方法对HE患者有益。新型治疗方法正在研究中,需要更多研究来验证其效果。

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本文引用的文献

1
Treating hepatic encephalopathy in cirrhotic patients admitted to ICU with sodium phenylbutyrate: a preliminary study.用苯丁酸钠治疗入住重症监护病房的肝硬化患者肝性脑病:一项初步研究。
Fundam Clin Pharmacol. 2018 Apr;32(2):209-215. doi: 10.1111/fcp.12340. Epub 2018 Jan 11.
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Safety, tolerability, and pharmacokinetics of l-ornithine phenylacetate in patients with acute liver injury/failure and hyperammonemia.L-鸟氨酸苯乙酸酯治疗急性肝损伤/衰竭伴高血氨症患者的安全性、耐受性和药代动力学。
Hepatology. 2018 Mar;67(3):1003-1013. doi: 10.1002/hep.29621. Epub 2018 Jan 30.
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L-ornithine L-aspartate in bouts of overt hepatic encephalopathy.门冬氨酸鸟氨酸治疗显性肝性脑病。
Hepatology. 2018 Feb;67(2):700-710. doi: 10.1002/hep.29410. Epub 2017 Dec 27.
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Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: A randomized clinical trial.来自合理粪便供体的粪便微生物群移植可改善肝性脑病:一项随机临床试验。
Hepatology. 2017 Dec;66(6):1727-1738. doi: 10.1002/hep.29306. Epub 2017 Oct 30.
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Randomized controlled trial comparing lactulose plus albumin versus lactulose alone for treatment of hepatic encephalopathy.比较乳果糖加白蛋白与单纯乳果糖治疗肝性脑病的随机对照试验。
J Gastroenterol Hepatol. 2017 Jun;32(6):1234-1239. doi: 10.1111/jgh.13666.
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An update on the use of benzoate, phenylacetate and phenylbutyrate ammonia scavengers for interrogating and modifying liver nitrogen metabolism and its implications in urea cycle disorders and liver disease.苯甲酸、苯乙酸和苯丁酸钠氨清除剂在研究和调节肝脏氮代谢中的应用进展及其在尿素循环障碍和肝脏疾病中的意义。
Expert Opin Drug Metab Toxicol. 2017 Apr;13(4):439-448. doi: 10.1080/17425255.2017.1262843. Epub 2016 Nov 28.
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Impact of ornithine phenylacetate (OCR-002) in lowering plasma ammonia after upper gastrointestinal bleeding in cirrhotic patients.鸟氨酸苯乙酸酯(OCR-002)对肝硬化患者上消化道出血后降低血浆氨水平的影响。
Therap Adv Gastroenterol. 2016 Nov;9(6):823-835. doi: 10.1177/1756283X16658252. Epub 2016 Jul 26.
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Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta-analysis.非吸收性二糖治疗肝性脑病:系统评价和荟萃分析。
Hepatology. 2016 Sep;64(3):908-22. doi: 10.1002/hep.28598. Epub 2016 May 20.
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Embolization of portosystemic shunts for treatment of medically refractory hepatic encephalopathy.经颈静脉肝内门体分流术栓塞术治疗内科难治性肝性脑病
Liver Transpl. 2016 Jun;22(6):723-31. doi: 10.1002/lt.24440.
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Hepatic Encephalopathy: Pharmacological Therapies Targeting Ammonia.肝性脑病:针对氨的药物治疗
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