肝性脑病综合综述:病理生理学、症状、流行病学、分类、诊断和治疗

Sandip Tejpal, Saajan Kumar Sharma, Astha Sharma, Sachit Sharma
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摘要

肝性脑病(HE)是一种可以逆转的大脑功能受损状态,严重肝病患者会出现这种症状。关于肝性脑病(HE)的确切病理生理学,目前仍在探索的主要假说包括:神经毒素、肝功能衰竭导致的代谢异常引起的神经传递减少、脑能量代谢的变化、全身炎症反应以及血脑屏障的改变。肝性脑病可引起的神经和精神症状严重程度不一。为了诊断局限性肝性脑病,需要使用异常心理测试。人格改变、意识状态改变、逐渐的时空错乱、嗜睡、昏迷和昏迷是高血压在临床上明显的一些特征。就诊断而言,在临床研究之外不需要进行特定的检测。肝性脑病可根据潜在疾病、症状严重程度、病程长短以及是否有导致其发生的诱因进行分类。肝性脑病指的是一系列可以治疗的神经精神疾病,其特点是肝病患者或接受门静脉分流术的患者会出现症状。头痛病是肝硬化导致的一种致残性疾病,有 35% 至 45% 的肝硬化患者会患上头痛病。在此之前,医院提供的头痛治疗选择主要取决于传闻证据、药物供应情况以及相关机构的规范。越来越多的随机对照试验(RCTs)进一步证实了基本肝病治疗技术(乳果糖、支链氨基酸和利福昔明)的重要意义,越来越多的证据也显示了这些策略的巨大优势。肝移植和大型 PSS 的栓塞这两种治疗方法已被证明对经过严格筛选的特定患者有效。它不仅对患者和照护者的日常生活产生重大影响,还与疾病和死亡率的增加有关,并消耗医疗系统的大量资源。在本文中,我们将探讨肝性脑病的历史,以及目前对该病的认识和可能的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Comprehensive Review on Hepatic Encephalopathy: Pathophysiology, Symptoms, Epidemiology, Classification, Diagnosis and Treatment
The condition known as hepatic encephalopathy (HE) is a state of impaired brain function that can be reversed and is experienced by patients who are suffering from severe liver diseases. Neurotoxins, decreased neurotransmission as a result of metabolic anomalies in liver failure, changes in brain energy metabolism, systemic inflammatory response, and alterations of the blood brain barrier are the primary hypotheses that are still being explored in relation to the precise pathophysiology of hepatic encephalopathy (HE). There is a wide spectrum of severity regarding the neurological and mental symptoms that can be brought on by HE. For the purpose of diagnosing limited HE, abnormal psychometric tests are utilised. Alterations in personality, altered states of consciousness, gradual spatial and temporal disorientation, lethargy, stupor, and coma are some of the characteristics of HE that are clinically noticeable. For the purpose of diagnosis, specific testing is not required outside of clinical studies. HE is classified according to the underlying disease, the severity of symptoms, the length of time it has been present, and whether or not there are triggers that cause it to occur. Hepatic encephalopathy refers to a collection of neuropsychiatric illnesses that can be treated and are characterised by the presence of symptoms in individuals who have liver disease or who have undergone portosystemic shunting. Entephalopathy, a disabling result of cirrhosis, affects thirty-five percent to forty-five percent of cirrhotic patients. Before recently, the treatment choices for HE that were available in hospitals were depending on anecdotal evidence, the availability of medication, and the norms of the relevant institutions. An increasing number of randomised controlled trials (RCTs) are providing further confirmation of the central significance of the basic HE therapy techniques (lactulose, branched-chain amino acids, and rifaximin), as well as the rising body of evidence showing the large beneficial advantages associated with these strategies. The liver transplantation and embolisation of large PSSs are two treatments that have proven to be effective for a select group of patients who have been carefully selected. Not only does it have a significant influence on the day-to-day lives of patients and carers, but it is also associated with increased rates of sickness and death and consumes a significant amount of resources in the healthcare system. In this article, we examine the history of hepatic encephalopathy, as well as the current understanding of the condition and the potential treatments for it.
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