Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
PLoS One. 2024 Sep 3;19(9):e0307899. doi: 10.1371/journal.pone.0307899. eCollection 2024.
Emerging research suggests that hyperammonemia may enhance the probability of hepatic encephalopathy (HE), a condition associated with elevated levels of circulating ammonia in patients with cirrhosis. However, some studies indicate that blood ammonia levels may not consistently correlate with the severity of HE, highlighting the complex pathophysiology of this condition.
A systematic review and meta-analysis through PubMed, Scopus, Embase, Web of Science, and Virtual Health Library were conducted to address this complexity, analyzing and comparing published data on various laboratory parameters, including circulating ammonia, blood creatinine, albumin, sodium, and inflammation markers in cirrhotic patients, both with and without HE.
This comprehensive review, which included 81 studies from five reputable databases until June 2024, revealed a significant increase in circulating ammonia levels in cirrhotic patients with HE, particularly those with overt HE. Notably, significant alterations were observed in the circulating creatinine, albumin, sodium, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNFα) in HE patients.
These findings suggest an association between ammonia and HE and underscore the importance of considering other blood parameters such as creatinine, albumin, sodium, and pro-inflammatory cytokines when devising new treatment strategies for HE.
新出现的研究表明，高血氨可能会增加肝性脑病（HE）的可能性，这种疾病与肝硬化患者循环氨水平升高有关。然而，一些研究表明，血氨水平可能并不总是与 HE 的严重程度相关，这突显了这种疾病复杂的病理生理学。
通过 PubMed、Scopus、Embase、Web of Science 和 Virtual Health Library 进行系统评价和荟萃分析，以解决这种复杂性，分析和比较了发表的关于各种实验室参数的数据，包括肝硬化患者的循环氨、血肌酐、白蛋白、钠和炎症标志物，包括有和没有 HE 的患者。
这项综合综述包括截至 2024 年 6 月来自五个知名数据库的 81 项研究，结果表明，HE 肝硬化患者的循环氨水平显著升高，尤其是那些有显性 HE 的患者。值得注意的是，HE 患者的循环肌酐、白蛋白、钠、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNFα）也发生了显著变化。
这些发现表明氨与 HE 之间存在关联，并强调在制定新的 HE 治疗策略时，除了考虑血氨之外，还应考虑其他血液参数，如肌酐、白蛋白、钠和促炎细胞因子。
