Nardelli Silvia, Gioia Stefania, Ridola Lorenzo, Riggio Oliviero
Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
Department of Gastroenterology, "Santa Maria Goretti" Hospital, "Sapienza" Polo Pontino, Latina, Italy.
J Clin Exp Hepatol. 2018 Dec;8(4):452-459. doi: 10.1016/j.jceh.2018.04.008. Epub 2018 May 5.
Hepatic Encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Several clinical and pathophysiologic observations suggest the importance of portal-systemic shunts in the development of HE. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. This latter type of HE should be related to spontaneous or radiological (such as Transjugular Intrahepatic Portosystemic Shunt (TIPS)) portal systemic shunts, that could be restricted or occluded in patients with chronic HE. Both TIPS reduction and shunt occlusion are radiological procedures, safe and effective to ameliorate neurological symptoms in patients with refractory HE.
肝性脑病（HE）是一种神经精神综合征，在高达30%的肝硬化患者中出现。HE可能是单纯肝衰竭的结果，如暴发性肝炎患者，或肝衰竭与门体分流相结合的结果，如肝硬化患者。多项临床和病理生理学观察表明门体分流在HE发生中的重要性。HE发作通常与诱发事件有关，如感染或胃肠道出血；少数肝硬化患者经历慢性HE，对标准药物治疗无效。后一种类型的HE应与自发性或放射学（如经颈静脉肝内门体分流术（TIPS））门体分流有关，在慢性HE患者中这种分流可被限制或闭塞。TIPS减少和分流闭塞都是放射学操作，对改善难治性HE患者的神经症状安全有效。
