Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Hepatology. 2019 Aug;70(2):640-649. doi: 10.1002/hep.30304. Epub 2019 Mar 4.
Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment frequently observable in patients with cirrhosis. Proton pump inhibitors (PPIs) can contribute to small-bowel bacterial overgrowth, but no study has investigated the link between PPIs and MHE. We investigated the relationship between MHE and PPI use as well as the role of PPI use in the development of overt HE and survival. Consecutive patients with cirrhosis (n = 310) were included in the study and followed up for 14.1 ± 12.3 months. At entry, MHE was diagnosed when the Psychometric Hepatic Encephalopathy Score was ≤-4. Data were analyzed by logistic regression for the factors associated with MHE and by time-related models for overt HE development and survival. At inclusion, 131 out of 310 patients with cirrhosis (42%) were affected by MHE. One hundred and twenty-five patients (40%) were using PPIs. The variables independently associated with the presence of MHE were PPI use, previous overt HE, low albumin, low sodium, and age. During follow-up, the development of overt HE was higher (64% versus 25%, P < 0.001) and overall survival lower (41% versus 81%, P < 0.001) in PPI users than in nonusers. Variables independently associated with the development of overt HE were PPIs, history of overt HE, low albumin, MHE, and age, while variables independently associated with mortality were PPIs, development of overt HE, Model for End-Stage Liver Disease score, low sodium, and age. Conclusion: The study identifies a potentially removable factor associated with the presence of MHE and related to the development of overt HE and survival in patients with liver cirrhosis.
轻微型肝性脑病（MHE）是肝硬化患者中经常观察到的一种亚临床认知障碍。质子泵抑制剂（PPIs）可导致小肠细菌过度生长，但尚无研究调查 PPI 与 MHE 之间的关系。我们研究了 MHE 与 PPI 使用之间的关系以及 PPI 使用在显性 HE 发展和生存中的作用。该研究纳入了连续的肝硬化患者（n=310），并随访了 14.1±12.3 个月。在入组时，当精神测肝性脑病评分≤-4 时诊断为 MHE。使用逻辑回归分析与 MHE 相关的因素，并使用时间相关模型分析显性 HE 发展和生存。在纳入时，310 例肝硬化患者中有 131 例（42%）患有 MHE。125 例患者（40%）正在使用 PPI。与 MHE 存在相关的独立变量是 PPI 使用、先前显性 HE、白蛋白低、钠低和年龄。在随访期间，PPI 使用者显性 HE 的发展（64%比 25%，P<0.001）和总体生存率（41%比 81%，P<0.001）均低于非使用者。与显性 HE 发展相关的独立变量是 PPI、显性 HE 病史、白蛋白低、MHE 和年龄，而与死亡率相关的独立变量是 PPI、显性 HE 发展、终末期肝病模型评分、钠低和年龄。结论：该研究确定了与 MHE 存在相关的潜在可消除因素，与肝硬化患者显性 HE 发展和生存相关。
