隐匿性肝性脑病的诊疗进展

隐匿性肝性脑病(minimal hepatic encephalopa-thy,MHE)又称亚临床肝性脑病(subclinicalhepatic encephalopathy,SHE),是慢性肝病和肝硬化最常见的严重并发症,是一种具有渐进性、可逆性的神经精神病学异常和运动功能失调特点的疾病.尽管其发病机制仍未明确,血清和中枢神经系统(central nervoussystem,CNS)血氨升高仍被认为是肝性脑病(hepatic encephalopathy,HE)的致病机制和治疗核心,并受血脑屏障改变、神经递质紊乱、氨基丁酸和苯二氮异常等因素影响.因此明确其诱发因素是HE治疗的关键.治疗药物包括抗生素、二糖类、益生菌、门冬氨酸鸟氨酸(L-ornithine-L-aspartate,LOLA)、苯甲/苯乙酸盐等.因此,对MHE的发病机制、临床诊断和治疗研究进展进行归纳,为临床诊疗提供前沿性、系统性信息,具有重要意义.

Advances in diagnosis and treatment of minimal hepatic encephalopathy

Minimal hepatic encephalopathy(MHE),also known as subclinical hepatic encephalopathy(SHE),is a common complex and potentially reversible neuropsychiatric syndrome secondary to chronic liver disease or cirrhosis.Although a clear pathogenesis is yet to be determined,elevated ammonia in serum and the central nervous system is the mainstay for pathogenesis and treatment of MHE.Patients with MHE,regardless of its cause,show a number of quantifiable neuropsychological defects,yet have a normal mental and neurological status on global clinical examination.Although ammonia is the main toxic substance involved in the pathogenesis of hepatic encephalopathy,other mechanisms,such as modifications of the blood-brain barrier,disruptions in neurotransmission and abnormalities in GABAergic and benzodiazepine pathways,may also play a role.Current treatments are based on reducing intestinal ammonia load by agents such as antibiotics,disaccharides and probiotics whose efficacy is yet to be clearly established.This paper summarizes the latest advances in the diagnosis and treatment of MHE.