Hu Yangyang, Zhang Xing, Xiao Ying, Wu Zhinian, Wang Yadong
Department of Infectious Diseases, Hebei Medical University Third Hospital, Shijiazhuang, China.
PLoS One. 2025 May 16;20(5):e0323359. doi: 10.1371/journal.pone.0323359. eCollection 2025.
Rifaximin (RFX) is recommended for the treatment of hepatic encephalopathy (HE). However, evidence on whether RFX application could yield additional benefits for preventing HE in patients with cirrhosis is limited. In this study, we aimed to assess the safety and efficacy of RFX in preventing HE. We conducted a systematic search of randomized controlled trials to evaluate the use of RFX by analyzing HE incidence, hospitalization, all-cause mortality, and adverse events. Compared with the control group, RFX had a beneficial effect on the primary prevention of HE (RR = 0.58, 95% CI: 0.50-0.68), with noncomparable effects to NADs (including lactulose and lactitol, RR = 0.65, 95% CI: 0.38-1.11), but more effective than placebo (RR = 0.57, 95% CI: 0.47-0.69). After more than 1 month of RFX treatment, the risk of HE decreased significantly (RR = 0.55, 95% CI: 0.47-0.65). In secondary prevention of HE, RFX decreased the recurrence risk (RR = 0.49, 95% CI: 0.40-0.61). RFX helped to reduce the incidence of HE after transjugular intrahepatic portosystemic stent shunt (TIPSS) (RR = 0.70, 95% CI: 0.51-0.96). In terms of adverse effects, RFX was associated with a lower risk of diarrhea than NADs (RR = 0.04, 95% CI: 0.00-0.25). So, RFX therapy is effective and well-tolerated in preventing HE, and can be used as the first choice in the prophylaxis of HE after TIPSS.
利福昔明（RFX）被推荐用于治疗肝性脑病（HE）。然而，关于RFX应用能否为肝硬化患者预防HE带来额外益处的证据有限。在本研究中，我们旨在评估RFX预防HE的安全性和有效性。我们对随机对照试验进行了系统检索，通过分析HE发病率、住院情况、全因死亡率和不良事件来评估RFX的使用情况。与对照组相比，RFX对HE的一级预防有有益作用（RR = 0.58，95%CI：0.50 - 0.68），与非吸收性双糖（NADs，包括乳果糖和乳糖醇）效果不可比（RR = 0.65，95%CI：0.38 - 1.11），但比安慰剂更有效（RR = 0.57，95%CI：0.47 - 0.69）。RFX治疗超过1个月后，HE风险显著降低（RR = 0.55，95%CI：0.47 - 0.65）。在HE的二级预防中，RFX降低了复发风险（RR = 0.49，95%CI：0.40 - 0.61）。RFX有助于降低经颈静脉肝内门体分流术（TIPSS）后HE的发生率（RR = 0.70，95%CI：0.51 - 0.96）。在不良反应方面，RFX导致腹泻的风险低于NADs（RR = 0.04，95%CI：0.00 - 0.25）。因此，RFX治疗在预防HE方面有效且耐受性良好，可作为TIPSS后预防HE的首选。
