Hasan Leen Z, Wu George Y
Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA.
J Clin Transl Hepatol. 2021 Oct 28;9(5):749-759. doi: 10.14218/JCTH.2021.00102. Epub 2021 Jun 22.
Hepatic encephalopathy is an often devastating complication of chronic liver disease, associated with high mortality and increased burden on patients and healthcare systems. Current agents (such as nonabsorbable disaccharides and oral antibiotics) are often only partially effective and associated with unpleasant side effects. With our improved understanding of the pathophysiology of hepatic encephalopathy, multiple treatment modalities have emerged with promising results when used alone or as an adjunct to standard medications. The mechanisms of these agents vary greatly, and include the manipulation of gut microbial composition, reduction of oxidative stress, inhibition of inflammatory mediators, protection of endothelial integrity, modulation of neurotransmitter release and function, and other novel methods to reduce blood ammonia and neurotoxins. Despite their promising results, the studies assessing these treatment modalities are often limited by study design, sample size, outcome assessment heterogeneity, and paucity of data regarding their safety profiles. In this article, we discuss these novel agents in depth and provide the best evidence supporting their use, along with a critical look at their limitations and future directions.
肝性脑病是慢性肝病常见的严重并发症，与高死亡率以及患者和医疗系统负担加重相关。目前的药物（如不吸收的双糖和口服抗生素）往往仅部分有效，且伴有令人不适的副作用。随着我们对肝性脑病病理生理学认识的提高，多种治疗方式应运而生，单独使用或作为标准药物的辅助治疗时均取得了有前景的结果。这些药物的作用机制差异很大，包括操纵肠道微生物组成、降低氧化应激、抑制炎症介质、保护内皮完整性、调节神经递质释放和功能，以及其他降低血氨和神经毒素的新方法。尽管取得了有前景的结果，但评估这些治疗方式的研究往往受到研究设计、样本量、结局评估异质性以及关于其安全性数据匮乏的限制。在本文中，我们深入讨论这些新型药物，提供支持其使用的最佳证据，并批判性地审视其局限性和未来方向。
