中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 6
Jun.  2010

The new concepts on hepatic encephalopathy

  • Published Date: 2010-06-20
  • 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.

     

  • [1]Blei AT, Cordoba J.Hepatic Encephalopathy[J].Am J Gastroenterol, 2001, 96 (7) ∶1968-1976.
    [2]Ferenci P, Lockwood A, Mullen K, et al.Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification:final report of the working party at the11th World Congresses of Gastroenterology, Vienna, 1998[J].Hepatology, 2002, 35 (3) ∶716721.
    [3]肝性脑病诊断治疗专家委员会.肝性脑病诊断治疗专家共识[J].中华实验和临床感染病杂志 (电子版) , 2009, 3 (4) ∶449-473.
    [4]涂传涛.肝性脑病的诊断方法及其研究进展[J].实用肝脏病杂志, 2009, 12 (2) ∶158-160.
    [5]颜迎春, 张明香.肝性脑病的现代治疗[J].中国现代医生, 2008, 46 (10) ∶22-23.
    [6]白启轩, 贾继东.肝性脑病的研究进展[J].现代消化及介入诊疗, 2009, 14 (1) ∶29-32.
    [7]Cordoba J, Raguer N, Flavia M, et al.T2hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities[J].Hepatology, 2003, 38 (4) ∶1026-1033.
    [8]Clemmesen JO, Larsen FS, Kondrup J, et al.Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration[J].Hepatology, 1999, 29 (3) ∶648-653.
    [9]Blei AT.The pathophysiology of brain edema in acute liver failure[J].Neurochem Int, 2005, 47 (1-2) :71-77.
    [10]王秋实, 刘辉, 梁长虹.33例活体肝脏磁共振氢质子波谱分析[J].山东医药, 2007, 47 (23) ∶67-68.
    [11]Huda A, Guze BH, Thomas A, et al.Clinical correlation of neuropsychological tests with1H magnetic resonance spectroscopy in hepatic encephalopathy[J].Psychosom Med, 1998, 60 (5) ∶550556.
    [12]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.
    [13]Rovira A, Alonso J, Cordoba J.MR imaging findings in hepatic encephalopathy[J].AJNR Am J Neuroradiol, 2008, 29 (9) ∶16121621.
    [14]Haussinger D, Schliess F.Pathogenetic mechanisms of hepatic encephalopathy[J].Gut, 2008, 57 (8) ∶1156-1165.
    [15]Bjerring PN, Eefsen M, Hansen BA, et al.The brain in acute liver failure.A tortuous path from hyperammonemia to cerebral edema[J].Metab Brain Dis, 2009, 24 (1) ∶5-14.
    [16]Manley GT, Fujimura M, Ma T, et al.Aquaporin-4deletion in mice reduces brain edema after acute water intoxication and ischemic stroke[J].Nat Med, 2000, 6 (2) ∶159-163.
    [17]Papadopoulos MC, Verkman AS.Aquaporin-4and brain edema[J].Pediatr Nephrol, 2007, 22 (6) ∶778-784.
    [18]Ellis AJ, Wendon JA, Williams R.Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure:a controlled clinical trial[J].Hepatology, 2000, 32 (3) ∶536-541.
    [19]Bhatia V, Batra Y, Acharya SK.Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure-a controlled clinical trial[J].J Hepatol, 2004, 41 (1) ∶89-96.
    [20]Walsh TS, Hopton P, Philips BJ, et al.The effect of N-acetylcysteine on oxygen transport and uptake in patients with fulminant hepatic failure[J].Hepatology, 1998, 27 (5) ∶1332-1340.
    [21]Strauss G, Hansen BA, Knudsen GM, et al.Hyperventilation restores cerebral blood flow autoregulation in patients with acute liver failure[J].J Hepatol, 1998, 28 (2) ∶199-203.
    [22]Shimomura Y, Honda T, Goto H, et al.Effects of liver failure on the enzymes in the branched-chain amino acid catabolic pathway[J].Biochem Biophys Res Commun, 2004, 313 (2) ∶381-385.
    [23]Honda T, Fukuda Y, Nakano I, et al.Effects of liver failure on branched-chain alpha-keto acid dehydrogenase complex in rat liver and muscle:comparison between acute and chronic liver failure[J].J Hepatol, 2004, 40 (3) ∶439-445.
    [24]Cordoba J, Lucke R.Driving under the influence of minimal hepatic encephalopathy[J].Hepatology, 2004, 39 (3) ∶599-601.
    [25]Cordoba J, Lopez-Hellin J, Planas M, et al.Normal protein diet for episodic hepatic encephalopathy:results of a randomized study[J].J Hepatol, 2004, 41 (1) ∶38-43.
    [26]Merli M, Riggio O.Dietary and nutritional indications in hepatic encephalopathy[J].Metab Brain Dis, 2009, 24 (1) ∶211-221.
    [27]Ahmad I, Khan AA, Alam A, et al.L-ornithine-L-aspartate infusion efficacy in hepatic encephalopathy[J].J Coll Physicians Surg Pak, 2008, 18 (11) ∶684-687.
    [28]Poo JL, Gongora J, Sanchez-Avila F, et al.Efficacy of oral L-ornithine-L-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy.Results of a randomized, lactulose-controlled study[J].Ann Hepatol, 2006, 5 (4) ∶281-288.
    [29]Acharya SK, Bhatia V, Sreenivas V, et al.Efficacy of L-ornithine L-aspartate in acute liver failure:a double-blind, randomized, placebo-controlled study[J].Gastroenterology, 2009, 136 (7) ∶2159-2168.
    [30]Soarez PC, Oliveira AC, Padovan J, et al.A critical analysis of studies assessing L-ornithine-L-aspartate (LOLA) in hepatic encephalopathy treatment[J].Arq Gastroenterol, 2009, 46 (3) ∶241-247.
    [31]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.
    [32]Jalan R, Wright G, Davies NA, et al.L-Ornithine phenylacetate (OP) :a novel treatment for hyperammonemia and hepatic encephalopathy[J].Med Hypotheses, 2007, 69 (5) ∶1064-1069.
    [33]Davies NA, Wright G, Ytrebo LM, et al.L-ornithine and phenylacetate synergistically produce sustained reduction in ammonia and brain water in cirrhotic rats[J].Hepatology, 2009, 50 (1) ∶155164.
    [34]Ytrebo LM, Kristiansen RG, Maehre H, et al.L-ornithine phenylacetate attenuates increased arterial and extracellular brain ammonia and prevents intracranial hypertension in pigs with acute liver failure[J].Hepatology, 2009, 50 (1) ∶165-174.
  • Relative Articles

    [1]Branch of Hepatobiliary Diseases, China Association of Chinese Medicine. Guideline for traditional Chinese medicine diagnosis and treatment of primary liver cancer[J]. Journal of Clinical Hepatology, 2024, 40(5): 919-927. doi: 10.12449/JCH240509
    [2]Yong LIN, Jiongfen LI, Feiyan LI, Yuanqin DU, Meiyan LIU, Minggang WANG, Fuli LONG, Na WANG, Dewen MAO. Role of neuroimmune communication via the gut-brain axis in the pathogenesis of hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2024, 40(12): 2518-2523. doi: 10.12449/JCH241224
    [3]Branch of Hepatobiliary Diseases, China Association of Chinese Medicine. Guidelines for traditional Chinese medicine diagnosis and treatment of liver cirrhosis[J]. Journal of Clinical Hepatology, 2024, 40(3): 461-472. doi: 10.12449/JCH240305
    [4]Chinese Association of Integrative Medicine, Chinese Association of Integrative Medicine, Chinese Medical Association. Guidelines for integrated traditional Chinese and Western medicine diagnosis and treatment of liver cirrhosis[J]. Journal of Clinical Hepatology, 2023, 39(11): 2543-2549. doi: 10.3969/j.issn.1001-5256.2023.11.005
    [5]Yuqin LIU, Mi CHEN, Lanyan TANG, Lizhi ZHOU, Xin HUANG, Pan ZHANG. Research advances in brain lactate level and hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2023, 39(7): 1728-1733. doi: 10.3969/j.issn.1001-5256.2023.07.031
    [6]Xianbo WANG, Ke SHI. Integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic encephalopathy: Advances and perspectives[J]. Journal of Clinical Hepatology, 2022, 38(9): 1969-1973. doi: 10.3969/j.issn.1001-5256.2022.09.004
    [7]Shuaijie QIAN, Hao WU. Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt[J]. Journal of Clinical Hepatology, 2021, 37(12): 2774-2777. doi: 10.3969/j.issn.1001-5256.2021.12.007
    [8]Li JianHong, Yao Jia, Yuan LiLi. Association between sarcopenia and hepatic encephalopathy and advances in diagnosis and treatment[J]. Journal of Clinical Hepatology, 2020, 36(6): 1412-1414. doi: 10.3969/j.issn.1001-5256.2020.06.049
    [9]China Association of Chinese Medicine. Guidelines for clinical diagnosis and treatment of acute-on-chronic liver failure in traditional Chinese  medicine[J]. Journal of Clinical Hepatology, 2019, 35(3): 494-503. doi: 10.3969/j.issn.1001-5256.2019.03.009
    [10]Li XiaoKe, Wang Shan, Li ZhiGuo, Gan DaNan, Ye YongAn. Updated key points of Guidelines for the diagnosis and management of hepatic encephalopathy in cirrhosis ( 2018)[J]. Journal of Clinical Hepatology, 2019, 35(7): 1485-1488. doi: 10.3969/j.issn.1001-5256.2019.07.012
    [11]Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. Journal of Clinical Hepatology, 2018, 34(10): 2076-2089. doi: 10.3969/j.issn.1001-5256.2018.10.007
    [12]Guo ZeQi, Wang QianYi, Qi XingShun, Jia JiDong. Recommendations for the diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases (2017)[J]. Journal of Clinical Hepatology, 2017, 33(12): 2275-2277. doi: 10.3969/j.issn.1001-5256.2017.12.003
    [13]Branch of Hepatobiliary Diseases, China Association of Chinese Medicine, Branch of Chinese Patent Medicine, China Association of Chinese Medicine. Guideline for diagnosis and treatment of herb-induced liver injury[J]. Journal of Clinical Hepatology, 2016, 32(5): 835-843. doi: 10.3969/j.issn.1001-5256.2016.05.003
    [14]Yan Ming. Selection of the diagnostic and therapeutic methods for minimal hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2016, 32(6): 1092-1099. doi: 10.3969/j.issn.1001-5256.2016.06.014
    [15]Sun RunFei, Wu Chao, Chen Xi, Sun MingYu. Research advances in integrated traditional Chinese and Western medicine diagnosis and treatment of minimal hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2016, 32(9): 1801-1805. doi: 10.3969/j.issn.1001-5256.2016.09.038
    [16]Zhao Kai, Zhang YueXin. Treatment of minimal hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2014, 30(10): 1094-1096. doi: 10.3969/j.issn.1001-5256.2014.10.030
    [17]Xu DaHai, Zhang Nan, Gao JinYing, Wu Yang. The therapeutic development of hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2011, 27(2): 218-221.
    [18]Ministry of Health of the People's Republic of China. Diagnosis, management, and treatment of hepatocellular carcinoma (V2011)[J]. Journal of Clinical Hepatology, 2011, 27(11): 1141-1159.
    [19]Jiang Hao, Xie Qing. Advances in the diagnosis and treatment of hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2011, 27(10): 1027-1031.
    [20]Zhang GuangShu, Shang QingHua, Xu ChuanZhen, Chen ChongQing, Yan ChengYu. Study on the pathogenesis and treatment of hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2001, 17(4): 241-243.
  • 加载中
    Created with Highcharts 5.0.7Chart context menuAccess Class DistributionFULLTEXT: 1.5 %FULLTEXT: 1.5 %META: 92.9 %META: 92.9 %PDF: 5.7 %PDF: 5.7 %FULLTEXTMETAPDF
    Created with Highcharts 5.0.7Chart context menuAccess Area Distribution其他: 5.7 %其他: 5.7 %其他: 0.2 %其他: 0.2 %China: 0.7 %China: 0.7 %[]: 0.2 %[]: 0.2 %内蒙古呼和浩特: 0.2 %内蒙古呼和浩特: 0.2 %北京: 6.7 %北京: 6.7 %南京: 1.0 %南京: 1.0 %南宁: 0.2 %南宁: 0.2 %吉林: 2.7 %吉林: 2.7 %呼和浩特: 0.7 %呼和浩特: 0.7 %哥伦布: 0.2 %哥伦布: 0.2 %圣彼得堡: 0.5 %圣彼得堡: 0.5 %大连: 0.5 %大连: 0.5 %宿迁: 1.2 %宿迁: 1.2 %崇左: 0.2 %崇左: 0.2 %常州: 0.5 %常州: 0.5 %张家口: 4.2 %张家口: 4.2 %德黑兰: 0.2 %德黑兰: 0.2 %成都: 0.5 %成都: 0.5 %新乡: 2.2 %新乡: 2.2 %无锡: 0.2 %无锡: 0.2 %杭州: 2.7 %杭州: 2.7 %武汉: 0.5 %武汉: 0.5 %淮安: 0.2 %淮安: 0.2 %深圳: 0.2 %深圳: 0.2 %玉林: 0.7 %玉林: 0.7 %芒廷维尤: 20.2 %芒廷维尤: 20.2 %苏州: 0.5 %苏州: 0.5 %莫斯科: 1.0 %莫斯科: 1.0 %西宁: 34.5 %西宁: 34.5 %贵港: 1.7 %贵港: 1.7 %连云港: 0.2 %连云港: 0.2 %郑州: 6.9 %郑州: 6.9 %长春: 0.2 %长春: 0.2 %长沙: 1.0 %长沙: 1.0 %马鞍山: 0.2 %马鞍山: 0.2 %其他其他China[]内蒙古呼和浩特北京南京南宁吉林呼和浩特哥伦布圣彼得堡大连宿迁崇左常州张家口德黑兰成都新乡无锡杭州武汉淮安深圳玉林芒廷维尤苏州莫斯科西宁贵港连云港郑州长春长沙马鞍山

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (4833) PDF downloads(1068) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return