肝性脑病临床诊治的进展

姜浩; 谢青

肝性脑病临床诊治的进展

姜浩,
谢青

上海交通大学医学院附属瑞金医院感染科

基金项目:

国家科技部十一五重大传染病专项(2008ZX10002-005,2008ZX10002-007)；

详细信息

中图分类号: R747.9
计量
- 文章访问数: 3574
- HTML全文浏览量: 13
- PDF下载量: 929
- 被引次数: 0
出版历程
- 收稿日期: 2011-09-12
- 出版日期: 2011-10-20

Advances in the diagnosis and treatment of hepatic encephalopathy

Jiang Hao,
Xie Qing

Research funding:

摘要

摘要: 肝性脑病(HE)是在各种急慢性及终末期肝病的基础上出现的以代谢紊乱为主要特征的神经、精神、功能失调综合征。目前一致认为,由于氨中毒及感染使星型胶质细胞肿胀及脑水肿,从而导致这些症状的出现。然而,导致脑部形态学改变的细胞学机制尚未明确。我们可以通过多种方法来诊断及评估不同程度的HE。HE的治疗主要是去除诱因,同时根据有效的经验用药来明确诊断。HE的经验用药主要是使用利福昔明及乳果糖以减少肠道内氨的产生与吸收。
- 肝性脑病
Abstract: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of both acute and chronic liver disease.Symptoms of HE can include confusion, disorientation and poor coordination.A general consensus exists that the synergistic effects of excess ammonia and inflammation cause astrocyte swelling and cerebral edema;however, the precise molecular mechanisms that lead to these morphological changes in the brain are unclear.The best treatment to HE is to remove causes and to clarify the diagnosis through empiric therapy.Empiric therapy for HE is largely based on the principle of reducing the production and absorption of ammonia in the gut through administration of pharmacological agents such as rifaximin and lactulose.
- hepatic encephalopathy

HTML全文

参考文献(10)

[1]Ferenci P, Lockwood A, Mullen K, et al.Hepatic encepha-lopathy-definition, nomenclature, diagnosis, and quantifica-tion:final report of the working party at the 11th World Con-gresses of Gastroenterology, vienna, 1998[J].Hepatology, 2002, 35 (3) :716-721.

[2]Rose C, Kresse W, Kettenmann H.Acute insult of ammonialeads to calcium-dependent glutamate release from culturedastrocytes, an effect of Ph[J].J Biol Chem, 2005, 280 (22) :20937-20944.

[3]Shawcross DL, Davies NA, Williams R, et al.Systemic in-flammatory response exacerbates the neuropsychologicaleffects of induced hyperammonemia in cirrhosis[J].J Hepa-tol, 2004, 40 (2) :247-254.

[4]Bajaj JS, Saeian K, Verber MD, et al.Inhibitory control testis a simple method to diagnose minimal hepatic encephalopa-thy and predict development of overt hepatic encephalopathy[J].Am J Gastroenterol, 2007, 102 (4) :754-760.

[5]Mardini H, Saxby BK, Record CO.Computerized psycho-metric testing in minimal encephalopathy and modulation bynitrogen challenge and liver transplant[J].Gastroenterolo-gy, 2008, 135 (5) :1582-1590.

[6]Plauth M, CabréE, Riggio O, et al.ESPEN Guidelines onEnteral Nutrition:Liver disease[J].Clin Nutr, 2006, 25 (2) :285-294.

[7]Muto Y, Sato S, Watanabe A, et al.Effects of oral branched-chain amino acid granules on event-free survival in pa-tients with liver cirrhosis[J].Clin Gastroenterol Hepatol, 2005, 3 (7) :705-713.

[8]Bass NM, Mullen KD, Sanyal A, et al.Rifaximin treatmentin hepatic encephalopathy[J].N Engl J Med, 2010, 362 (12) :1071-1081.

[9]Stewart CA, Malinchoc M, Kim WR, et al.Hepatic encepha-lopathy as a predictor of survival in patients with end-stageliver disease[J].Liver Transpl, 2007, 13 (10) :1366-1371.

[10]Albrecht J.Cyclic GMP in blood and minimal hepatic enceph-alopathy:fine-tuning of the diagnosis[J].J Mol Med, 2007, 85 (3) :203-205.

施引文献

资源附件(0)

访问统计