Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montreal, Canada.
Department of Medicine, University of Padova, Padova, Italy.
J Hepatol. 2020 Dec;73(6):1526-1547. doi: 10.1016/j.jhep.2020.07.013. Epub 2020 Oct 21.
Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed.
肝性脑病（HE）是慢性肝病和急性肝衰竭的常见且严重的并发症。HE 表现为广泛的神经精神异常，从亚临床改变（轻度认知障碍）到明显的定向障碍、意识混乱和昏迷。HE 的临床和经济负担相当大，极大地导致生活质量受损、发病率和死亡率升高。这篇综述将批判性地讨论 HE 的最新分类，以及终末期肝病患者神经功能下降的发病机制和病理生理途径。此外，还讨论了管理策略、诊断方法、现有治疗选择和新的治疗策略。
