Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, United Kingdom.
Section of Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany.
Semin Respir Crit Care Med. 2018 Oct;39(5):523-537. doi: 10.1055/s-0038-1672180. Epub 2018 Nov 28.
Hepatic encephalopathy (HE) is a severe complication of liver disease, describing a spectrum of neurological and psychiatric abnormalities ranging from subclinical alterations to coma. HE is the leading cause for hospital readmission, intensive care treatment, and mortality in patients with chronic liver disease. The complex and multifaceted pathogenesis is not yet fully understood, but hypotheses focus on ammonia and systemic inflammation, which are the main targets for currently available therapies in clinical practice. Nevertheless, the remaining high clinical relevance and healthcare burden of this syndrome underlines the emergence for further unraveling the full spectrum of pathomechanisms, as this provides the basis for the development of novel, highly targeted therapies. In this review, the most recent literature about current and future therapies for HE, relevant for intensive care management, will be discussed.
肝性脑病 (HE) 是肝脏疾病的严重并发症，描述了一系列从亚临床改变到昏迷的神经和精神异常。HE 是导致慢性肝病患者住院、重症监护治疗和死亡的主要原因。其复杂和多方面的发病机制尚未完全了解，但假说集中在氨和全身炎症上，这是目前临床实践中可用疗法的主要靶点。然而，该综合征在临床上仍然具有很高的相关性和医疗负担，这突显了进一步阐明其全谱发病机制的必要性，因为这为开发新的、高度靶向的疗法提供了基础。在这篇综述中，将讨论与重症监护管理相关的、关于 HE 的当前和未来治疗方法的最新文献。
