Treatment of minimal hepatic encephalopathy
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摘要: 轻微肝性脑病(MHE)是肝性脑病发病的起始阶段,无明显的临床表现,但是对患者的日常生活安全产生了严重的影响,在现代医学中受到越来越多的重视,治疗方法主要包括去除诱因和药物治疗两个部分。介绍了轻微肝性脑病的相关治疗,并对各种治疗方案的疗效进行了客观评价。认为现治疗方案主要是多种治疗方法的联合应用,但没有试验证明联合应用可提高疗效。Abstract: Minimal hepatic encephalopathy ( MHE) is defined as early hepatic encephalopathy without grossly evident neurologic abnormalities, but with cognitive deficits that can be revealed by psychometric testing. However, numerous studies have shown a lack of obvious clinical manifestations in MHE patients, and there is no international unified diagnostic gold standard for this disease. Affected patients' quality of life and ability to work are markedly impaired, and some even gradually progress to symptomatic hepatic encephalopathy. The treatment methods for MHE mainly include eliminating the precipitating factors for this disease and medication. This review presents the options for treatment of MHE and gives an objective evaluation of the efficacy of each treatment scheme. Currently, several treatment methods are used together, but no studies have demonstrated that combined use of treatment methods can improve the treatment outcome.
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Key words:
- hepatic encephalopathy /
- drug therapy /
- review
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[1]DHIMAN RK, SARASWAT VA, SHARMA BK, et al.Minimal hepatic encephalopathy:consensus statement of a working part of the Indian National Association for Study of the Liver[J].J Gastroenterol Hepatol, 2010, 25 (6) :1029-1041. [2]LI SW, XU JM, HU KF, et al.Prevalence of minimal hepatic encephalopathy and analysis of associated risk factors[J].Chin J Gastroenterol Hepatol, 2012, 21 (2) :176-179. (in Chinese) 李素文, 许建明, 胡凯风, 等.轻微肝性脑病患病情况调查及相关危险因素分析[J].胃肠病学和肝病学杂志, 2012, 21 (2) :176-179. [3]LIN Y, FAN YP.The neuropsychologic tests and the minimal hepatic encephalopathy investigations in liver cirrhotic patients[J].Chin J Hepatol, 2011, 19 (1) :65-66. (in Chinese) 林言, 范燕萍.肝硬化患者的神经心理测验及轻微肝性脑病调查[J].中华肝脏病杂志, 2011, 19 (1) :65-66. [4]ZHAN T, STREMMEL W.The diagnosis and treatment of minimal hepatic encephalopathy[J].Dtsch Arztebl Int, 2012, 109 (10) :180-187. [5]MONTGOMERY JY, BAJAJ JS.Advances in the evaluation and management of minimal hepatic encephalopathy[J].Curr Gastroenterol Rep, 2011, 13 (1) :26-33. [6]MULLWN KD, PRAKASH RK.Management of covert hepatic encephalopathy[J].Clin Liver Dis, 2012, 16 (1) :91-93. [7]BAJAJ JS, SAEIAN K, SCHUBERT CM, et al.Minimal hepatic encephalopathy is associated with motor vehicle crashes:the reality beyond the driving test[J].Hepatology, 2009, 50 (4) :1175-1183. [8]BAJAJ JS, HEUMAN DM, WADE JB, et al.Rifaximin improves driving simulator performance in a randomizes trial of patients with minimal hepatic encephalopathy[J].Gastroenterology, 2011, 140 (2) :478-487. [9]PRAKASH R, MULLEN KD.Mechanisms, diagnosis and management of hepatic encephalopathy[J].Nat Rev Gastroenterol Hepatol, 2010, 7 (9) :515-525. [10]WEN J, LIU Q, SONG J, et al.Lactulose is highly potential in prophylaxis of hepatic encephalopathy in patients with cirrhosis and upper gastrointestinal bleeding:results of a controlled randomized trial[J].Digestion, 2013, 87 (2) :132-138. [11]MITTAL VV, SHARMA BC, SHARMA P, et al.A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy[J].Eur J Gastroenterol Hepatol, 2011, 23 (8) :725-732. [12]BAJAJ JS, HEUMAN DM, SANYAL AJ, et al.Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy[J].PLoS One, 2013, 8 (4) :e60042. [13]SIDHU SS, GOYAL O, MISHRA BP, et al.Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial) [J].Am J Gastroenterol, 2011, 106 (2) :307-316. [14]SAJI S, KUMAR S, THOMAS V.A randomized double blind placebo controlled trial of probiotics in minimal hepatic encephalopathy[J].Trop Gastroenterol, 2011, 32 (2) :128-132. [15]SHARMA P, SHARMA BC, PURI V.An open-label randomized controlled trial of lactuloseand probiotics in the treatment of minimal hepatic encephalopathy[J].Eur J Gastroenterol Hepatol, 2008, 20 (6) :506-511. [16]SHUKLA S, SHUKLA A, MEHBOOB S, et al.Meta-analysis:the effects of gut flora modulationusing prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy[J].Aliment Pharmacol Ther, 2011, 33 (6) :662-671. [17]LES I, DOVAL E, GARCIA-MARTINEZ R, et al.Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy:a randomized study[J].Am J Gastroenterol, 2011, 106 (6) :1081-1088. [18]BAI M, YANG Z, QI X, et al.l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis:a meta-analysis of randomized controlled trials[J].J Gastroenterol Hepatol, 2013, 28 (5) :783-792. [19]KATO A, TANAKA H, KAWAGUCHI T, et al.Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis:A preliminary, prospective, open-label study[J].Hepatol Res, 2013, 43 (5) :452-458. [20]VAISMAN N, KATZMAN H, CARMIEL-HAGGAI M, et al.Breakfast improves cognitive function in cirrhotic patients with cognitive impairment[J].Am J Clin Nutr, 2010, 92 (1) :137-140.
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