当前肝性脑病的管理:综述文章

Jaya Ghosh, Jhumur Ghosh
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引用次数: 0

摘要

肝性脑病是一种由肝功能衰竭引起的神经精神综合征,表现为急性和慢性病例。其发展背后的主要原因涉及大脑中氨水平升高导致的神经毒性,这可能是由于氨产生增加或氨排泄受损而发生的。治疗肝性脑病的主要目的是降低氨水平。在这种情况下,氨的解毒是由两种酶调节的:谷氨酰胺酶和谷氨酰胺合成酶。许多药物,如乳果糖、利福昔明、BCAA、LOLA、苯基丁酸甘油和锌,已被用于治疗肝性脑病。在未来的研究中,需要对粪便菌群移植、益生菌、溴隐亭、米诺环素、吲哚美辛、布洛芬和氟马西尼等实验性治疗方案进行研究。此外,白蛋白输注已被证明可以增强认知功能和改善生活的社会心理质量,可能是通过减轻轻度肝性脑病或既往肝性脑病发作患者的内皮功能障碍。本文综述了目前肝性脑病的治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current Management of Hepatic Encephalopathy: A Review Article
Hepatic encephalopathy, a neuropsychiatric syndrome stemming from liver failure, manifests in acute and chronic cases. The prevailing cause behind its development involves the neurotoxicity resulting from elevated ammonia levels in the brain, which can occur due to increased ammonia production or impaired ammonia excretion. The main objective in treating hepatic encephalopathy is to decrease ammonia levels. The detoxification of ammonia in this condition is regulated by two enzymes: glutaminase and glutamine synthetase. Numerous drugs, such as lactulose, rifaximin, BCAA, LOLA, glycerol phenylbutyrate, and zinc, have been utilized to treat hepatic encephalopathy. In terms of future research, experimental treatment options like fecal microbiota transplant, probiotics, bromocriptine, minocycline, indomethacin, ibuprofen, and flumazenil warrant investigation. Furthermore, albumin infusions have been shown to enhance cognitive function and improve the psychosocial quality of life, possibly by alleviating endothelial dysfunction in patients with minimal hepatic encephalopathy or previous episodes of hepatic encephalopathy. This review article offers a comprehensive overview of the current management strategies for hepatic encephalopathy.
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