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肝性脑病诊断治疗新认识
The new concepts on hepatic encephalopathy
文章发布日期:2010年10月19日  来源:  作者:王宇明,晏泽辉  点击次数:4187次  下载次数:943次

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【摘要】:新近我国出台了《肝性脑病(HE)诊断治疗专家共识》,成为国际上两个指南的重要补充。按照第11届消化病学大会(WCOG)工作小组的标准,我国的HE以C型为主。同时,HBV携带者首次发病出现重症化时实际系因大块或亚大块肝坏死所致急性肝衰竭(ALF),其HE的机制与C型不同,处理也不同。因此,我国的HE患者除C型外,A型也不少见。磁共振波谱学(MRS)、脑部单光子发射断层扫描(SPECT)和正电子发射断层扫描(PET)是近年来发展较快的HE无创性检查手段。脑水肿发生机制的研究新进展有星形胶质细胞肿胀、细胞外谷氨酸盐变化、脑循环障碍等,而相应对策有NAC、镇静剂、脱水及低温疗法等。关于BCAA疗法,经证实BCAA代谢在ALF是降低的,而在CLF则是增高的,提示前者不宜补充BCAA制剂,后者则可补充BCAA制剂。目前用于HE治疗的药物主要有鸟氨酸-门冬氨酸(OA)、不吸收抗生素和不吸收双糖,而L-鸟氨酸-乙酸苯酯(OP)作为清除血氨的一种新的治疗药物,具有重要的潜在应用价值。
【Abstract】:The consensus of hepatic encephalopathy (HE) has been newly published in China to be the supplement to the two national guidelines. According to 11th World Congresses of Gastroenterology (WCOG) proposed classification, type C encephalopathy is mostly seen in China.Moreover, a big portion of ALF is actually happened in HBV carriers for the large and sub-bulk hepatic necrosis. However, type A associated with acute liver failure (ALF), is not rare, Brain MRI, CT, MRS, SPE-CT and PET-CT may provide useful information in diagnosis. Brain edema has been found to play an important role in the pathogenesis of HE, especially in patients with ALF. The new progress of pathogenetic mechanisms in brain edema include astrocyte swelling, extracellula glutamine change and disturbance of cerebral circulation, and the corresponding management are NAC treatment, tranquilizer, dehydration and hypothermia therapy. Intake of BCAA and protein should mainly depend on the types of HE. It has been proved BCAA reduce in ALF but increase in CLF, which implicate it’s not suitable to supplement BCAA to the former but the latter. L-Ornithine-L-aspartate (OA) and nonabsorbable antibiotics and disaccharides are currently extensively used in HE, and L-Ornithine phenylacetate (OP) has potential value of application in HE.
【关键字】:肝性脑病;诊疗准则
【Key words】:hepatic encephalopathy; practice guideline
【引证本文】:

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