Wibawa I Dewa Nyoman, Mariadi I Ketut, Shalim Christina Permata, Sindhughosa Dwijo Anargha
Head of Department of Internal Medicine and Endoscopic Unit BaliMed Hospital, Denpasar, Bali, Indonesia.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia.
Clin Exp Hepatol. 2023 Jun;9(2):146-153. doi: 10.5114/ceh.2023.128768. Epub 2023 Jun 23.
Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has shown benefit in some clinical trials. This review aimed to systematically analyze the efficacy of probiotics in the treatment of MHE.
A systematic search of the electronic databases PubMed, Science Direct, and Cochrane Library was conducted for randomized controlled trials (RCTs) in adult patients with MHE who had been given probiotics intervention. The primary outcomes were reversal of MHE and improvement of neuropsychometric tests, while the secondary outcome was the reduction of serum ammonia.
Nine RCTs involving 776 MHE patients were included, consisting of 311 patients receiving probiotics and 465 patients receiving comparator (placebo or no treatment, lactulose, L-ornithine L-aspartate [LOLA], or rifaximin). The meta-analysis showed that probiotics significantly reversed MHE (OR = 3.95, < 0.0001, 95% CI: 2.05 to 7.60) compared with placebo or no treatment. Probiotics also significantly reduced serum ammonia compared with placebo (pooled mean difference -25.94, = 0.04, 95% CI: -50.21 to -1.66). However when compared to lactulose and LOLA, probiotics did not show a significant difference in reversal of MHE or reduction of serum ammonia levels.
Probiotics were more effective in reversal of MHE and reduced serum ammonia levels in patients with MHE compared to placebo or no treatment, but not more effective than lactulose or LOLA.
轻微肝性脑病（MHE）患者没有可识别的肝性脑病（HE）临床症状，但已证实其轻度认知和精神运动功能障碍会对他们的日常功能和生活质量产生负面影响。益生菌治疗在一些临床试验中已显示出益处。本综述旨在系统分析益生菌治疗MHE的疗效。
对电子数据库PubMed、Science Direct和Cochrane图书馆进行系统检索，以查找接受益生菌干预的成年MHE患者的随机对照试验（RCT）。主要结局是MHE的逆转和神经心理测试的改善，次要结局是血清氨的降低。
纳入了9项涉及776例MHE患者的RCT，其中311例患者接受益生菌治疗，465例患者接受对照治疗（安慰剂或不治疗、乳果糖、L-鸟氨酸L-天冬氨酸[LOLA]或利福昔明）。荟萃分析表明，与安慰剂或不治疗相比，益生菌能显著逆转MHE（OR = 3.95，P < 0.0001，95%CI：2.05至7.60）。与安慰剂相比，益生菌还能显著降低血清氨（合并平均差异-25.94，P = 0.04，95%CI：-50.21至-1.66）。然而，与乳果糖和LOLA相比，益生菌在逆转MHE或降低血清氨水平方面没有显著差异。
与安慰剂或不治疗相比，益生菌在逆转MHE和降低MHE患者血清氨水平方面更有效，但不比乳果糖或LOLA更有效。
