González-Regueiro J A, Higuera-de la Tijera M F, Moreno-Alcántar R, Torre A
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México.
Departamento de Gastroenterología, Hospital General de México, Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2019 Apr-Jun;84(2):195-203. doi: 10.1016/j.rgmx.2019.02.004. Epub 2019 Apr 20.
Understanding of the pathophysiology of hepatic encephalopathy has conditioned new treatment options. Ammonia detoxification in hepatic encephalopathy is regulated by two enzymes: glutaminase or glutamine synthetase. The first produces ammonia and the second detoxifies the ammonia, which is why treatments are aimed at glutaminase inhibition or glutamine synthetase activation. At present, we know that both enzymes are found not only in the liver, but also in the muscle, intestine, kidney, and brain. Therefore, current treatments can be directed at each enzyme at different sites. Awareness of those potential treatment sites makes different options of approach possible in the patient with hepatic encephalopathy, and each approach should be personalized.
对肝性脑病病理生理学的理解催生了新的治疗选择。肝性脑病中的氨解毒由两种酶调节：谷氨酰胺酶或谷氨酰胺合成酶。第一种酶产生氨，第二种酶使氨解毒，这就是治疗旨在抑制谷氨酰胺酶或激活谷氨酰胺合成酶的原因。目前，我们知道这两种酶不仅存在于肝脏中，还存在于肌肉、肠道、肾脏和大脑中。因此，目前的治疗可以针对不同部位的每种酶。了解这些潜在的治疗部位使得肝性脑病患者有不同的治疗方法可供选择，并且每种方法都应该个性化。
