轻微肝性脑病的中西医诊疗进展

孙润菲; 武超; 陈曦; 孙明瑜

doi:10.3969/j.issn.1001-5256.2016.09.038

轻微肝性脑病的中西医诊疗进展

DOI: 10.3969/j.issn.1001-5256.2016.09.038

1. 上海中医药大学附属曙光医院，上海中医药大学肝病研究所，肝肾疾病病证教育部重点实验室
2. 上海市中医药研究院

基金项目:

国家自然科学基金项目(81273729)；上海中医药大学首届杏林学者、上海市科委专项(15DZ1900104)；上海高校创新团队建设项目、国家中医药管理局中医肝胆病重点学科、慢性肝病虚损重点研究室和上海市中医临床重点实验室资助；

详细信息

中图分类号: R575.3
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出版历程
- 出版日期: 2016-09-20

Research advances in integrated traditional Chinese and Western medicine diagnosis and treatment of minimal hepatic encephalopathy

Shuguang Hospital, Shanghai University of Traditional Chinese Medicine

Research funding:

摘要

摘要:
轻微肝性脑病(MHE)是肝硬化患者疾病进程中较为常见的并发症,会给患者本身及社会造成较为严重的危害。该病临床症状隐匿,用精细的智力测验和神经电生理检查可以发现智力及神经精神方面的异常。若不经过及时治疗,极易发展成为肝性脑病。综述了国内外学者在MHE发病机制方面的研究成果,以及传统医学及现代医学在MHE治疗方面取得的成绩。
- 肝性脑病 /
- 诊断 /
- 治疗 /
- 综述
Abstract:
Minimal hepatic encephalopathy( MHE) is a common complication in the progression of liver cirrhosis,and cando great harm to patients and the society. This disease has hidden clinical symptoms,and fine intelligence tests and nerve electrophysiological examination can find abnormalities in intelligence and mental status. If no treatment is given in time,MHE can easily progress to hepatic encephalopathy. Therefore,it is important to clarify the pathogenesis of MHE and give a definite diagnosis. MHE has a complex pathogenesis,and scholars at home and abroad have put forward various hypotheses based on in- depth studies. In recent years,great achievements have been made in traditional Chinese and Western medicine for the treatment of MHE. This article reviews resarch advances in the pathogenesis of MHE worldwide and achievements in the diagnosis and treatment of MHE based on traditional Chinese and Western medicine.
- hepatic encephalopathy /
- diagnosis /
- therapy /
- review

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参考文献(45)

[1]AMODIO P,MONTAGNESE S,GATTA A,et al.Characteristics of minimal hepatic encephalopathy[J].Metab Brain Dis,2004,19(3-4):253-267.

[2]CORDOBA J.New assessment of hepatic encephalopathy[J].J Hepatol,2011,54(5):1030-1040.

[3]GHOSH S,van HEEL D,PLAYFORD RJ.Probiotics in inflammatory boweldisease:is it all gut flora modulation[J].Gut,2004,53(5):620-622.

[4]BAJAJ JS.Minimal hepatic encephalopathy matters in daily life[J].World J Gastroenterol,2008,14(23):3609-3615.

[5]ROMERO-GOMEZ M,BOZA F,GARCIA-VALDECASAS MS,et al.Subclinical hepatic encephalopathy predicts the development of overthepatic encephalopathy[J].Am J Gastroenterol,2001,96(27):18-23.

[6]ROMERO-GOMEZ M,GRANDE L,CAMACHO I,et al.Alteredresponse to oral glutamine challenge as prognostic factor for overt episodes inpatients with minimal hepatic encephalopathy[J].J Hepatol,2002,37(6):781-787.

[7]ISHII T,TAKATORI K,IIDA K,et al.Optimum conditions for the13C-phenylalanine breath test[J].Chem Pharm Bull,1998,46(8):1330-1332.

[8]DHIMAN RK,SARASWAT VA,SHARMA BK,et al.Minimal hepatic encephalopathy:consensus statement of a working party of the Indian National Association for Study of the Liver[J].J Gastroenterol Hepatol,2010,25(6):1029-1041.

[9]LUO M,LI L,YANG EN,et al.Relationship between interleukin-6 and ammonia in patients with minimal hepatic encephalopathy due to liver cirrhosis[J].Hepatol Res,2012,42(12):1202-1210.

[10]OELTZSCHNER G,BUTZ M,BAUMGARTEN TJ,et al.Low visual cortex GABA levels in hepatic encephalopathy:links to bloodammonia,critical flicker frequency,and brain osmolytes[J].Metab Brain,2015,30(6):1429-1438.

[11]l LANSOLA M,MONTOLIU C,AGUSTI A,et al.Interplay between glutamatergic and GABAergic neurotransmission alterations in cognitive and motor impairment in minimal hepatic encephalopathy[J].Neurochem Int,2015,12(88):15-19.

[12]QI R,ZHANG L,WU S,et al.Altered resting-statebrain activity at functional MR imaging during the progression of hepatic encephalopathy[J].Radiology,2012,264(1):187-195.

[13]CHEN HJ,ZHU XQ,JIAO Y,et al.Abnormal baseline brain activity in low-grade hepatic encephalopathy:a resting-state f MRI study[J].J Neurol Sci,2012,318(1-2):140-145.

[14]LV XF,YE M,HAN LJ,et al.Abnormal baseline brainactivity in patients with HBV-related cirrhosis without overt hepatic encephalopathy revealed by resting-state functional MRI[J].Metab Brain Dis,2013,28(3):485-492.

[15]MONTOLIU C,PIEDRAFITA B,SERRA MA,et al.IL-6 and IL-18 in blood may discriminate cirrhotic patients with and without minimal hepatic encephalopathy[J].J Clin Gastroenterol,2009,43(3):272-279.

[16]BEMEUR C,QU H,DESJARDINS P,et al.IL-1 or TNF receptor gene deletion delays onset of encephalopathy and attenuates brain edema in experimental acute liver failure[J].Neurochem Int,2010,56(2):213-215.

[17]ONAL IK,AKDOGAN M,OZTAS E,et al.Does interleukin-18play a role in the pathogenesis of hepatic encephalopathy[J].Hepatogastroenterology,2011,58(106):497-502.

[18]LOCKWOOD AH,WEISSENBORN K,BOKEMEYER M,et al.Correlations between cerebral glucose metabolism and neuropsychological test performance in nonalcoholiccirrhotics[J].Metab Brain Dis,2002,17(1):29-40.

[19]HERNNDEZ-RABAZA V,CABRERA-PASTOR A,TAOROGONZLEZ L,et al.Hyperammonemia induces glial activation,neuroinflammation and alters neurotransmitter receptors in hippocampus,impairing spatial learning:reversal by sulforaphane[J].J Neuroinflammation,2016,13:41.

[20]MULLENKD.Review of the final report of the 1998 working party ondefinition,nomenclature and diagnosis of hepatic encephalopathy[J].Aliment Pharmacol Ther,2007,25(Suppl 1):11-16.

[21]FERENCI P,LOCKWOOD A,MULLEN K,et al.Hepatic encephalopathy-definition,nomenclature,diagnosis,and quantification:final report of the working party at the 11th World Congresses of Gastroenterology,Vienna,1998[J].Hepatology,2002,35(3):716-721.

[22]ROMERO-GOMEZ M,CORDOBA J,JOVER R,et al.Value of the critical flicker frequencyin patients with minimal hepaticencephalopathy[J].Hepatology,2007,45(4):879-885.

[23]AMODIO P,CAMPAGNA F,OLIANAS S,et al.Detection of minimal hepatic normalization and optimization of the psychometric hepatic encephalopathy score.A neuropsychological and quantified EEG study[J].J Hepatol,2008,49(3):346-356.

[24]ROBIN H,TAREK H,MEGHAC,et al.Cognitive functioning and psychiatric symptom atology in patients with chronic hepatit is C[J].J Int Neuropsychol Soc,2003,9(1):847-854.

[25]ZHAO K,ZHANG YX.Treatment of minimal hepatic encephalopathy[J].J Clin Hepatol,2014,30(10):1094-1096.(in Chinese)赵凯,张跃新.轻微肝性脑病的治疗现状[J].临床肝胆病杂志,2014,30(10):1094-1096.

[26]WANG GD,SU QF,ZHANG HW.Efficacy of naloxone versus lactulose in treatment of minimal hepatic encephalopathy in patients with liver cirrhosis:a comparative analysis[J].China Prac Med,2012,7(34):123-124.(in Chinese)王国栋,苏钦峰,张红伟.纳洛酮乳果糖治疗肝硬化轻微肝性脑病对照分析[J].中国实用医药,2012,7(34):123-124.

[27]LLAMAS MA,ALLER MA,MARQUINA D,et al.Bacterial translocation to mesenteric lymph nodes increases in chronic portal hypertensive rats[J].Dig Dis Sci,2010,55(8):2244-2254.

[28]GIBSON GR,WANG X.Regulatory effects of bifidobacteria on the growth of other colonic bacteria[J].Appl Bacteriol,2012,77(4):412-420.

[29]MARCHESI JR,DUTILH BE,HALL N,et al.Towards the human colorectal cancer microbiome[J].PLo S One,2011,6(5):e20447.

[30]CHEN SY,LI ZZ,CHEN F.The research of safety and function of probiotics in human gut[J].Chin J Microb,2007,4(19):397-398.

[31]RIORDAN SM,WILLIAMS R.Gut flora and hepatic encephalopathy in patients with cirrhosis[J].N Engl J Med,2010,362(12):1140-1142.

[32]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.

[33]LUO M.Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy:a meta-analysis[J].Eur J Gastroenterol Hepatol,2011,23(12):1250-1257.

[34]PRASAD S.Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encepahlopathy[J].Hepatology,2007,45(3):549-559.

[35]LI YQ,CHEN ZF,FENG SG,et al.The therapeutic effects of naloxone on 36 patients with subclinical hepatic encephalopathy[J].Med Inf,2005,18(5):498-500.(in Chinese)李英强,陈志锋,冯少刚,等.纳洛酮治疗亚临床型肝性脑病疗效观察[J].医学信息,2005,18(5):498-500.

[36]BASS NM,MULLEN KD,SANYAL A,et al.Rifaximin treatment in hepaticencephalopathy[J].N Engl J Med,2010,362(12):1071-1072.

[37]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.

[38]ZHANG YY,FENG YK,CAO B,et al.Effects of SIBO and rifaximin therapy on MHE caused by hepatic cirrhosis[J].Int J Clin Exp Med,2015,8(2):2954-2957.

[39]SHARMA K,PANT S,MISRA S,et al.Effect of Rifaximin,Probiotics,and l-Ornithine l-Aspartate on Minimal Hepatic Encephalopathy:a randomized controlled trial[J].Saudi J Gastroenterol,2014,20(4):225-232.

[40]ZHANG HB.The development of minimal hepatic encephalopathy[J].J Emerg Tradit Chin Med,1997,6(2):87-90.(in Chinese)张洪斌.肝性脑病的中医研究进展[J].中国中医急症,1997,6(2):87-90.

[41]YAO C,ZHONG Y,YAO F,et al.A review on treating minimal hepatic encephalopathy in the integrative medicine[J].Hunan J Tradit Chin Med,2015,31(1):149-150.(in Chinese)姚春,钟宇,姚凡,等.中西医治疗轻微型肝性脑病的研究进展[J].湖南中医杂志,2015,31(1):149-150.

[42]WEI X,CHENG WL,ZHANG RZ.Efficacy of Rheum officinale decoction in treatment of minimal hepatic encephalopathy:a clinical study[J].J Changchun Univ Tradit Chin Med,2011,27(1):26-27.(in Chinese)韦新,程万里,张荣臻.大黄煎剂治疗轻微肝性脑病的临床研究[J].长春中医药大学学报,2011,27(1):26-27.

[43]LIU H,LIANG Y,LIU YY,et al.Therapeutical effects of rehmannia and stores in on minimal hepatic encephalopathy in rat model[J].Chin J Rehabil Theory Pract,2010,16(10):904-906.(in Chinese)刘赫,梁妍,刘雁勇,等.地黄苏合香合剂对轻微肝性脑病模型大鼠治疗的实验研究[J].中国康复理论与实践,2010,16(10):904-906.

[44]ZHUO YH,CHEN JJ,WANG LT.Influence of“Qing Kai Granules”on morphology of rat liver with acute liver necrosis[J].Acta Univ Tradit Med Sin Pharmacol Shanghai,2002,16(3):54-56.(in Chinese)卓蕴慧,陈建杰,王灵台.清开颗粒对急性肝坏死大鼠肝脏的组织学影响[J].上海中医药大学学报,2002,16(3):54-56.

[45]CHANG J,PAN XF,QIU WW.Efficacy of spleen-strengthening and resuscitation-inducing decoction in treatment of subclinical hepatic encephalopathy:a clinical study[J].Med J Chin PLA,2006,31(10):1027.(in Chinese)常洁,潘雪飞,邱蔚蔚.健脾醒神汤治疗亚临床肝性脑病的临床观察[J].解放军医学杂志,2006,31(10):1027.

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