Hiramine Yasunari, Uto Hirofumi, Mawatari Seiichi, Kanmura Shuji, Imamura Yasushi, Hiwaki Takuya, Saishoji Akiko, Kakihara Atsuko, Maenohara Shigeho, Tokushige Koichi, Ido Akio
Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
Center for Digestive and Liver Diseases, Miyazaki Medical Center Hospital, Miyazaki, Japan.
Hepatol Res. 2021 Apr;51(4):445-460. doi: 10.1111/hepr.13622. Epub 2021 Mar 9.
Rifaximin is recommended as treatment for hepatic encephalopathy (HE) that targets intestinal bacterial flora. Although combined use with synthetic disaccharides is the standard of care worldwide, the therapeutic effects of rifaximin for overt encephalopathy (OHE) in Japanese patients have not been examined sufficiently. We examined the therapeutic effects of rifaximin for OHE in Japanese patients.
A total of 76 patients who developed OHE of West Haven grade II or higher at least once within the 12 months before starting rifaximin were included. Blood ammonia levels and the incidence of OHE during the 12 months before and after starting rifaximin therapy were compared in a before-and-after study. Rifaximin efficacy and predictors of efficacy were also examined.
Post-treatment blood ammonia levels were significantly lower than pretreatment levels. The mean annual number of OHE incidents and intravenous branched-chain amino acid preparations used per patient were significantly lower after starting rifaximin therapy (2.51 vs. 0.76 times/year, p < 0.001; and 71.9 vs. 20.7 preparations/year, p = 0.003, respectively). The cumulative incidence of hospitalizations associated with HE significantly decreased after rifaximin therapy (hazard ratio 0.187; p < 0.001). The efficacy rate, defined as the proportion of patients without OHE during the administration of rifaximin for 1 year after starting rifaximin therapy, was 65.8%. Serum albumin ≥2.7 g/dl was an independent predictor of efficacy.
Rifaximin was associated with decreased blood ammonia levels, lower incidence of OHE, and fewer hospitalizations in Japanese patients with HE. In addition, serum albumin level was an important predictor on efficacy of rifaximin.
利福昔明被推荐用于治疗以肠道菌群为靶点的肝性脑病（HE）。尽管与合成二糖联合使用是全球的治疗标准，但利福昔明对日本患者显性肝性脑病（OHE）的治疗效果尚未得到充分研究。我们研究了利福昔明对日本OHE患者的治疗效果。
纳入76例在开始使用利福昔明前12个月内至少发生过一次西港分级II级或更高等级OHE的患者。在一项前后对照研究中，比较了开始利福昔明治疗前后12个月内的血氨水平和OHE发生率。还研究了利福昔明的疗效及疗效预测因素。
治疗后血氨水平显著低于治疗前。开始利福昔明治疗后，每位患者每年OHE发作的平均次数及静脉使用支链氨基酸制剂的数量均显著降低（分别为2.51次/年对0.76次/年，p<0.001；71.9制剂/年对20.7制剂/年，p=0.003）。利福昔明治疗后，与HE相关的住院累积发生率显著降低（风险比0.187；p<0.001）。在开始利福昔明治疗后1年的给药期间无OHE的患者比例定义的有效率为65.8%。血清白蛋白≥2.7g/dl是疗效的独立预测因素。
在日本HE患者中，利福昔明与血氨水平降低、OHE发生率降低及住院次数减少有关。此外，血清白蛋白水平是利福昔明疗效的重要预测因素。
