CIBM Center for Biomedical Imaging, Lausanne, Switzerland.
Animal Imaging and Technology, EPFL, Lausanne, Switzerland.
Metab Brain Dis. 2024 Mar;39(3):403-437. doi: 10.1007/s11011-023-01269-5. Epub 2023 Aug 22.
Brain edema is considered as a common feature associated with hepatic encephalopathy (HE). However, its central role as cause or consequence of HE and its implication in the development of the neurological alterations linked to HE are still under debate. It is now well accepted that type A and type C HE are biologically and clinically different, leading to different manifestations of brain edema. As a result, the findings on brain edema/swelling in type C HE are variable and sometimes controversial. In the light of the changing natural history of liver disease, better description of the clinical trajectory of cirrhosis and understanding of molecular mechanisms of HE, and the role of brain edema as a central component in the pathogenesis of HE is revisited in the current review. Furthermore, this review highlights the main techniques to measure brain edema and their advantages/disadvantages together with an in-depth description of the main ex-vivo/in-vivo findings using cell cultures, animal models and humans with HE. These findings are instrumental in elucidating the role of brain edema in HE and also in designing new multimodal studies by performing in-vivo combined with ex-vivo experiments for a better characterization of brain edema longitudinally and of its role in HE, especially in type C HE where water content changes are small.
脑水肿被认为是肝性脑病（HE）的常见特征。然而，它作为 HE 的病因或后果的核心作用及其在与 HE 相关的神经功能障碍发展中的作用仍存在争议。现在人们普遍认为，A型和 C 型 HE 在生物学和临床上是不同的，导致脑水肿的表现也不同。因此，C 型 HE 中脑水肿的发现是可变的，有时甚至存在争议。鉴于肝病的自然病程发生变化，更好地描述肝硬化的临床病程，理解 HE 的分子机制，以及脑水肿作为 HE 发病机制的核心组成部分的作用，在本综述中重新进行了探讨。此外，本综述重点介绍了测量脑水肿的主要技术及其优缺点，并深入描述了使用细胞培养物、动物模型和 HE 患者的主要离体/体内发现。这些发现有助于阐明脑水肿在 HE 中的作用，并通过进行体内和体外联合实验来设计新的多模态研究，以更好地纵向描述脑水肿及其在 HE 中的作用，特别是在脑水肿变化较小的 C 型 HE 中。
