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ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 6
Jun.  2016
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Selection of the diagnostic and therapeutic methods for minimal hepatic encephalopathy

DOI: 10.3969/j.issn.1001-5256.2016.06.014
  • Published Date: 2016-06-20
  • Currently,since there is still no “gold standard”for the diagnosis of minimal hepatic encephalopathy(MHE),a “quick and simple”diagnosis cannot be made,and a diagnosis needs a comprehensive evaluation.Some new detection techniques,such as imaging examination,have shown their advantages and may become new directions for the research and development of diagnostic methods in the future.The treatment of MHE should focus on eliminating precipitating factors,regulating diets,and preventing and blocking the increase in blood ammonia.Moreover,the communication and guidance between doctors and patients on diet regulation are necessary and important.

     

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  • [1]VILSTRUP H,AMODIO P,BAJAJ J,et al.Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases[J].Hepatology,2014,60(2):715-735.
    [2]LAURIDSEN MM,VILSTRUP H.Diagnosing covert hepatic encephalopathy:diagnosing covert hepatic encephalopathy[J].Clin Liver Dis,2015,5(3):71-74.
    [3]WEISSENBORN K,ENNEN JC,SCHOMERUS H,et al.Neuropsychological characterization of hepatic encephalopathy[J].J Hepatol,2001,34(5):768-773.
    [4]AMODIO P,CAMPAGNA F,OLIANAS S,et al.Detection of minimal hepatic encephalopathy:normalization and optimization of the Psychometric Hepatic Encephalopathy Score.Aneuropsychological and quantified EEG study[J].J Hepatol,2008,49(3):346-353.
    [5] ROMERO-GMEZ M,CRDOBA J,JOVER R,et al.Value of the critical flicker frequency in patients with minimal hepatic encephalopathy[J].Hepatology,2007,45(4):879-885.
    [6] GONG YX.Revision of wechsler adult intelligence scale[J].Acta Psychol Sin,1983,15(3):362-369.(in Chinese)龚耀先.韦氏成人智力量表的修订[J].心理学报,1983,15(3):362-369.
    [7]YE RF,GONG YX.Neuropsychological tests in patients with liver cirrhosis[J].Chin Mental Health J,2001,15(4):254-259.(in Chinese)叶瑞繁,龚耀先.神经心理学测验与亚临床肝性脑病的检测[J].中国心理卫生杂志,2001,15(4):254-259.
    [8]LIN Y,FAN YP,YU JJ,et al.Diagnostic value of the evoked potentials in liver cirrhotic patients with minimal hepatic encephalopathy[J].Chin J Dig,2010,30(7):444-447.(in Chinese)林言,范燕萍,余建军,等.诱发电位对肝硬化患者轻微肝性脑病的诊断价值[J].中华消化杂志,2010,30(7):444-447.
    [9]KULLMANN F,HOLLERBACH S,LOCK G,et al.Brain electrical activity mapping of EEG for the diagnosis of subclinical hepatic encephalopathy in chronic liver disease[J].Eur J Gastroenterol Hepatol,2001,13(5):513-522.
    [10] BERNTHAL P,HAYS A,TARTER RE,et al.Cerebral CT scan abnormalities in cholestatic and hepatocellular disease and their relationship to neuropsychologic test performance[J].Hepatology,1987,7(1):107-114.
    [11]KRIEGER D,KRIEGER S,JANSEN O,et al.Manganese and chronic hepatic encephalopathy[J].Lancet,1995,346(8970):270-274.
    [12]CHEN XR,SHEN TZ,TANG WJ,et al.Functional MRI---Ahot research topic in neuroimaging[J].Chin Comput Med Imag,2004,10(5):289-291.(in Chinese)陈星荣,沈天真,汤伟军,等.功能性磁共振成像---神经影像学的研究热点[J].中国医学计算机成像杂志,2004,10(5):289-291.
    [13]GEISSLER A,LOCK G,FRND R,et al.Cerebral abnormalities in patients with cirrhosis detected by proton magnetic resonance spectroscopy and magnetic resonance imaging[J].Hepatology,1997,25(1):48-54.
    [14]HASSAN EA,ABD EL-REHIM AS,SEIFELDEIN GS,et al.Minimal hepatic encephalopathy in patients with liver cirrhosis:magnetic resonance spectroscopic brain findings versus neuropsychological changes[J].Arab J Gastroenterol,2014,15(3-4):108-113.
    [15] FURUYA S,NARUSE S,IDE M,et al.The clinical application of multi-voxel 1H-CSI(chemical shift imaging)in brain tumors[J].Nihon Igaku Hoshasen Gakkai Zasshi,1991,51(7):836-838.
    [16]KANG JY.Influencing factors of MR diffusion-weighted signal[J].J Dalian Med Univ,2004,26(2):152.(in Chinese)康建蕴.影响磁共振弥散加权成像信号的因素[J].大连医科大学学报,2004,26(2):152.
    [17]THOMALLA G,GLAUCHE V,KOCH MA,et al.Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke[J].Neuroimage,2004,22(4):1767-1774.
    [18] AKBAR N,LOBAUGH NJ,O'CONNOR P,et al.Diffusion tensor imaging abnormalities in cognitively impaired multiple sclerosis patients[J].Can J Neurol Sci,2010,37(5):608-614.
    [19]KONG X,QI RF,LIANG X,et al.Study of voxel-based whole brain diffusion tensor imaging in cirrhotic patients[J].Radiol Pract,2014,29(1):16-20.(in Chinese)孔祥,戚荣丰,梁雪,等.肝硬化患者基于体素的全脑扩散张量成像研究[J].放射学实践,2014,29(1):16-20.
    [20]HENKELMAN RM,STANISZ GJ,GRAHAM SJ.Magnetization transfer in MRI:a review[J].NMR Biomed,2001,14(2):57-64.
    [21] ROVIRA A,GRIVE E,PEDRAZA S,et al.Magnetization transfer ratiovalues and proton MR spectroscopy of normal-appearing cerebral white matter in patients with liver cirrhosis[J].AJNR Am J Neuroradiol,2001,22(6):1137-1142.
    [22]JING B,SHEN W,ZHANG LJ,et al.Quantitative analysis of brain changes of hepatic encephalopathy with magnetization transfer imaging[J].Chin J Med Imaging Technol,2009,25(4):581-584.(in Chinese)姜滨,沈文,张龙江,等.磁化传递成像定量研究肝硬化肝性脑病患者肝移植前后的脑改变[J].中国医学影像技术,2009,25(4):581-584.
    [23]CORDOBA J,ALONSO J,ROVIRA A,et al.The development of low-grade cerebral edema in cirrhosis is supported by the evolution of 1H-magnetic resonance abnormalities after liver transplantation[J].JHepatol,2001,35(5):598-604.
    [24]YAZGAN Y,NARIN Y,DEMIRTURK L,et al.Value of regional cerebral blood flow in the evaluation of chronic liver disease and subclinical hepatic encephalopathy[J].J Gastroenterol Hepatol,2003,18(10):1162-1167.
    [25] LOCKWOOD AH,MURPHY BW,DONNELLY KZ,et al.Positronemission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy[J].Hepatology,1993,18(5):1061-1068.
    [26] TOWNSEND DW,CARNEY JP,YAP JT,et al.PET/CT today and tomorrow[J].J Nucl Med,2004,45(Suppl 1):4s-14s.
    [27]NAKAGAWA Y,MATSUMURA K,IWASA M,et al.Single photon emission computed tomography and statistical parametric mapping analysis in cirrhotic patients with and without minimal hepatic encephalopathy[J].Ann Nucl Med,2004,18(2):123-129.
    [28]YANG G,LI L,LIANG Q.Characteristics and clinical use of various functional imaging technologies[J].Inf Med Equip,2007,22(12):38-40.(in Chinese)杨刚,李林,良泉.不同功能成像技术的特性与临床应用[J].医疗设备信息,2007,22(12):38-40.
    [29]ORTIZ M,JACAS C,CRDOBA J.Minimal hepatic encephalopathy:diagnosis clinical significance and recommendations[J].JHepatol,2005,42(Suppl 1):s45-s53.
    [30]de RUI M,MONTAGNESE S,AMODIO P.Recent developments in the diagnosis and treatment of covert/minimal hepatic encephalopathy[J].Expert Rev Gastroenterol Hepatol,2016,10(4):443-450.
    [31]SHARMA P,SHARMA BC,SARIN SK,et al.Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis[J].Hepatobiliary Pancreat Dis Int,2010,9(1):27-32.
    [32]LIU DS,GAO W,YAN M,et al.The brainstem auditory evoked potentials in subclinical hepatic encephalopathy[J].Shangdong J Biomed Eng,2002,21(4):36-37.(in Chinese)刘德山,高伟,阎明,等.脑干听觉诱发电位检测对亚临床肝性脑病的诊断价值[J].山东生物医学工程,2002,21(4):36-37.
    [33]LIU DS,CHAI Q,GAO W,et al.Study of visual and somatosensory evoked potentials in the patients with liver cirrhosis[J].J Biomed Eng Res,2003,22(3):33-35.(in Chinese)刘德山,柴青,高伟,等.肝硬化患者视觉和体感诱发电位的研究[J].生物医学工程研究,2003,22(3):33-35.
    [34] KUGLER CF,LOTTERER E,PETTER J,et al.Visual event-related P300 potentials in early portosystemic encephalopathy[J].Gastroenterology,1992,103(1):302-310.
    [35]NADIM MK,DURAND F,KELLUM JA,et al.Management of the critically ill patient with cirrhosis:a multidisciplinary perspective[J].J Hepatol,2016,64(3):717-735.
    [36] WEISSENBORN K.Challenges in diagnosing hepatic encephalopathy[J].Neurochem Res,2015,40(2):265-273.
    [37]SCHOMERUS H,HAMSTER W,BLUNCK H,et al.Latent portasystemic encephalopathy.I.Nature of cerebral functional defects and their effect on fitness to drive[J].Dig Dis Sci,1981,26(7):622-630.
    [38]LALAMA MA,SALOUM Y.Nutrition,fluid and electrolytes in chronic liver disease[J].Clin Liver Dis,2016,7(1):18-20.
    [39]MAHARSHI S,SHARMA BC,SACHDEVA S,et al.Efficacy of nutritional therapy for patients with cirrhosis and minimal hepatic encephalopathy in a randomized trial[J].Clin Gastroenterol Hepatol,2016,14(3):454-460.
    [40]WANG YM,YAN ZH.The new concepts on hepatic encephalopathy[J].J Clin Hepatol,2010,26(6):568-574.(in Chinese)王宇明,晏泽辉.肝性脑病诊断治疗新认识[J].临床肝胆病杂志,2010,26(6):568-574.
    [41] BIANCHI GP,MARCHESINI G,FABBRI A,et al.Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy.A randomized cross-over comparison[J].J Intern Med,1993,233(5):385-392.
    [42]NGUYEN DL,MORGAN T.Protein restriction in hepatic encephalopathy is appropriate for selected patients:a point of view[J].Hepatol Int,2014,8(2):447-451.
    [43] BADEA MA,PRELIPCEAN CC,MIHAI C,et al.Current concepts in minimal hepatic encephalopathy[J].Rev Med Chir Soc Med Nat Iasi,2015,119(1):9-17.
    [44]BAJAJ JS.Minimal hepatic encephalopathy matters in daily life[J].World J Gastroenterol,2008,14(23):3609-3615.
    [45]PRASAD S,DHIMAN RK,DUSEJA A,et al.Lactulose improves cognitive functions and health-related quality of life cirrhosis who have minimal hepatic encephalopathy[J].Hepatology,2007,45(3):549-559.
    [46]GENTILE S,GUARINO G,ROMANO M,et al.A randomized controlled trial of acarbose in hepatic encephalopathy[J].Clin Gastroenterol Hepatol,2005,3(2):184-191.
    [47] 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.
    [48]GUPTA A,DHIMAN RK,KUMARI S,et al.Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy[J].J Hepatol,2010,53(5):849-855.
    [49]SIRINGO S,VAIRA D,MENEGATTI M,et al.High prevalence of helicobacter pylori in liver cirrhosis:relationship with clinical and endoscopic features and the risk of peptic ulcer[J].Dig Dis Sci,1997,42(10):2024-2030.
    [50]ABDEL-HADY H,ZAKI A,BADRA G,et al.Helicobacter pylori infection in hepatic encephalopathy:relationship to plasma endotoxins and blood ammonia[J].Hepatol Res,2007,37(12):1026-1033.
    [51]MIQUEL J,BARCENA R,BOIXEDA D,et al.Role of Helicobacter pylori infection and its eradication in patients with subclinical hepatic encephalopathy[J].Eur J Gastroenterol Hepatol,2001,13(9):1067-1072.
    [52]WU J.Role of Helicobacter pylori in pathogenesis of minimal hepatic encephalopathy and clinical impact after the treatment of HP[J].Chin J Nosocomiol,2013,23(15):3642-3644.(in Chinese)吴娟.幽门螺杆菌在轻微肝性脑病发病机制中的作用及HP根治治疗后临床影响[J].中华医院感染学杂志,2013,23(15):3642-3644.
    [53]WANG LJ,CAI JT,CHEN T,et al.The effects of Helicobacter pylori infection on hyperammonaemia and hepatic encephalopathy in cirrhotic patients[J].Chin J Intern Med,2006,45(8):654-657.(in Chinese)王良静,蔡建庭,陈涛,等.幽门螺杆菌感染对高氨血症和肝性脑病发病的影响[J].中华内科杂志,2006,45(8):654-657.
    [54]WANG KJ,SONG HM.L-Ornithine-L-Aspartate for the treatment of cirrhotic patients with hepatic encephalopathy:a meta-analysis[J].Chin Gen Pract,2012,15(30):3451-3454.(in Chinese)王旷靖,宋汉明.L鸟氨酸L门冬氨酸治疗肝硬化肝性脑病的Meta分析[J].中国全科医学,2012,15(30):3451-3454.
    [55]LI YY.Treatment of hepatic encephalopathy and minimal hepatic encephalopathy with L-ornitine-L-aspartate[J].J Clin Hepatol,2011,27(1):100-102.(in Chinese)李瑜元.门冬氨酸鸟氨酸治疗显性和轻微型肝性脑病[J].临床肝胆病杂志,2011,27(1):100-102.
    [56] JIANG Q,JIANG XH,ZHENG MH,et al.L-Ornithine-L-aspartate in the management of hepatic encephalopathy:a meta-analysis[J].J Gastroenterol Hepatol,2009,24(1):9-14.
    [57]Chinese Society of Gastroenterology and Chinese Society of Hepatology,Chinese Medical Association.Consensus on the diagnosis and treatment of hepatic encephalopathy in China(Chongqing,2013)[J].Chin J Hepatol,2013,21(9):641-651.(in Chinese)中华医学会消化病学分会,中华医学会肝病学分会.中国肝性脑病诊治共识意见(2013年,重庆)[J].中华肝脏病杂志,2013,21(9):641-651.
    [58] TANG XL,HU L,SHENG RL.Efficacy of arginine in treatment of hepatic encephalopathy in patients with liver cirrhosis and severe hepatitis[J].J Chin Mod Med,2006,3(5):580-581.(in Chinese)汤习良,胡莉,盛瑞玲.精氨酸对肝硬化与重症型肝炎中肝性脑病的疗效观察[J].中华现代内科杂志,2006,3(5):580-581.
    [59] LEMBERG A,FERNNDEZ MA.Hepatic encephalopathy,ammonia,glutamate,glutamine and oxidative stress[J].Ann Hepatol,2009,8(2):95-102.
    [60]YAN M,ZHANG SZ,ZHAO XC,et al.An analysis of serum aminogram of subclinical hepatic encephalopathy60[J].Chin J Hepatol,1998,6(2):116.(in Chinese)〗阎明,张尚忠,赵宪村,等.亚临床型肝性脑病的血清氨基酸谱分析[J].中华肝脏病杂志,1998,6(2):116.
    [61]MARCHESINI G,BIANCHI G,MERLI M,et al.Nutritional supplementation with branched-chain amino acids in advanced cirrhosis:a double-blind,randomized trial[J].Gastroenterology,2003,124(7):1792-1801.
    [62] GLUUD LL,DAM G,LES I,et al.Branched-chain amino acids for people with hepatic encephalopathy[J].Cochrane Database Syst Rev,2015,9:CD001939.
    [63] DAM G,KEIDING S,MUNK OL,et al.Branched-chain amino acids increase arterial blood ammonia in spite of enhanced intrinsic muscle ammonia metabolism in patients with cirrhosis and healthy subjects[J].Am J Physiol Gastrointest Liver Physiol,2011,301(2):g269-g277.
    [64]DAM G,OTT P,AAGAARD NK,et al.Branched-chain amino acids and muscle ammonia detoxification in cirrhosis[J].Metab Brain Dis,2013,28(2):217-220.
    [65] LES I,DOVAL E,GARCIA-MARTINEZ R,et al.Effects of branched-chain aminoacids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy:a randomized study[J].Am J Gastroenterol,2011,106(6):1081-1088.
    [66]HOLECEK M.Branched-chain amino acids and ammonia metabolism in liver disease:therapeutic implications[J].Nutrition,2013,29(10):1186-1191.
    [67]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.
    [68]SEYAN AS,HUGHES RD,SHAWCROSS DL.Changing face of hepatic encephalopathy:role of inflammation and oxidative stress[J].World J Gastroenterology,2010,16(27):3347-3357.
    [69]GLUUD LL,DAM G,BORRE M,et al.Lactulose,rifaximin or branched chain amino acids for hepatic encephalopathy:what is the evidence?[J].Metab Brain Dis,2013,28(2):221-225.
    [70] SIMON-TALERO M,VENTURA M,CORDOBA J.Minimal hepatic encephalopathy[M].//Gines P,Forns X,Fernandez J,Crespo G,et al.Therapy in Liver Diseases,Barcelona:Elsevier Doyma.2013:151-157.
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