轻微型肝性脑病发病机制的研究进展
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摘要
轻微型肝性脑病(MHE)是指在肝硬化患者中不能通过临床检查发现的轻度的神经认知功能障碍,其影响到社会交往、情绪行为、睡眠障碍、身体和精神症状及生活质量等下降。早期诊断与治疗可以有效改善患者的生活质量,防止其进展到临床肝性脑病(HE)具有重要的意义。近年来,众多学者在认识该疾病方面也取得了显著成果,文章就MHE的流行病学特征及其发病机制作一综述,以期为临床治疗更深入地探讨奠定理论基础。
Minimal hepatic encephalopathy(MHE) is a mild neurocognitive disorder that cannot be detected by clinical examination in patients with liver cirrhosis. It affects social interaction, emotional behavior, sleep disorders, physical and mental symptoms and quality of life. Early diagnosis and treatment can effectively improve the quality of life of patients and prevent their progression to clinical hepatic encephalopathy(HE) has important significance. In recent years, many scholars have made remarkable achievements in understanding the disease. This article reviews the epidemiological characteristics and pathogenesis of MHE, in order to lay a theoretical foundation for further clinical study.
Minimal hepatic encephalopathy(MHE) is a mild neurocognitive disorder that cannot be detected by clinical examination in patients with liver cirrhosis. It affects social interaction, emotional behavior, sleep disorders, physical and mental symptoms and quality of life. Early diagnosis and treatment can effectively improve the quality of life of patients and prevent their progression to clinical hepatic encephalopathy(HE) has important significance. In recent years, many scholars have made remarkable achievements in understanding the disease. This article reviews the epidemiological characteristics and pathogenesis of MHE, in order to lay a theoretical foundation for further clinical study.
引文
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[24]Marshall J C.The gut as a potential trigger of exerciseinduced inflammatory responses[J].Canadian Journal of Physiology and Pharmacology,1998,76(5):479-484.
[25]Sampson T R,Mazmanian S K.Control of brain development,function,and behavior by the microbiome[J].Cell Host Microbe,2015,17(5):565-576.
[26]Williams B B,Van Benschoten A H,Cimermancic P,et al.Discovery and characterization of gut microbiota decarboxylases that can produce the neurotransmitter tryptamine[J].Cell Host Microbe,2014,16(4):495-503.
[27]Holzer P.Neuropeptides,Microbiota,and Behavior[J].Int Rev Neurobiol,2016,131:67-89.
[28]Gareau M G.Cognitive Function and the Microbiome[J].Int Rev Neurobiol,2016,131:227-246.
[29]Frederick RT.Current concepts in the pathophysiology and management of hepatic encephalopathy[J].Gastroenterol Hepatol,2011,7(4):222-233.
[30]LIANG Shuwen,QU Changmin,WANG Xiaoying,et al Clinical research on intestinal flora changes in patients with hepatic encephalopathy[J].J Med Res,2015,44(11):68-70.
[31]Qin J,Li R,Raes J,et al.A human gut microbial gene catalogue established by metagenomic sequencing[J].Nature,2010464(7285):59-65.
[32]杨育林,沈雁,杨法根,等.微生态制剂联合肠内营养治疗肝性脑病的临床研究[J].中国中西医结合消化杂志,2014,22(4):173-177.
[33]朱小区,吴春明,陶玉,等.清腑灌肠方保留灌肠对肝性脑病患者LPS、TNF-α和IL-6的影响[J].中国中医急症,201423(3):389-390.
[34]Wijarnpreecha K,Chesdachai S,Thongprayoon C,et al,Association of helicobacter pylori with the risk of hepatic encephalopathy[J].Dig Dis Sci,2017,62(12):3614-3621.
[2]Souto P A,Marcotegui A R,Orbea L,et al.Hepatic encephalopathy Ever closer to its big bang[J].World Journal of Gastroenterology,2016,22(42):9251-9256.
[3]Schulz C,Schutte K,Kropf S,et al.RiMINI-the influence of rifaximin on minimal hepatic encephalopathy(MHE)and on the intestinal microbiome in patients with liver cirrhosis:study protocol for a randomized controlled trial[J].Trials,2016,17(1):111.
[4]杨廷旭,高毅英,康发财,等.轻微肝性脑病区域性流行病学调查及中西医结合干预研究[J].中国临床研究,2015,28(4):540-542.
[5]苏常春,麦玉冰,曾峥,等.亚临床肝性脑病患者BAEP的研究[J].临床神经电生理学杂志,2008(3):157-159.
[6]Ferenci P,Lockwood A,Mullen K,et al.Hepatic encephalopathy-Definition,nomenclature,diagnosis,and quantificatio[J].Hepatology,2002,35(3):716-721.
[7]中华医学会肝病学分会.肝硬化肝性脑病诊疗指南[J].临床肝胆病杂志,2018,34(10):2076-2089.
[8]王军,张流,熊华刚,等.醒脑静联合纳洛酮治疗肝性脑病患者认知和血清炎症因子水平变化[J].实用肝脏病杂志,201821(3):471-472.
[9]Labenz C,Baron J S,Toenges G,et al.Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients[J].Alimentary Pharmacology&Therapeutics,2018,48(3):313-321.
[10]Sharon G,Sampson T R,Geschwind D H,et al.The Central Nervous System and the Gut Microbiome[J].Cell,2016,167(4):915-932.
[11]Borrelli L,Aceto S,Agnisola C,et al.Probiotic modulation of the microbiota-gut-brain axis and behaviour in zebrafish[J].Scientific Reports,2016,6:30046.
[12]Macpherson A,Heikenwalder M,Ganal-Vonarburg S.The liver at the nexus of host-microbial interactions[J].Cell Host&Microbe,2016,20(5):561-571.
[13]陆伦根.肝性脑病:离我们并不遥远[J].中华消化杂志,2017(8):508-512.
[14]Holecek,Milan.Evidence of a vicious cycle in glutamine synthesis and breakdown in pathogenesis of hepatic encephalopathy-therapeutic perspectives[J].Metabolic Brain Disease,2014,29(1):9-17..
[15]Clayton M.Hepatic encephalopathy:causes and health-related burden[J].British Journal of Nursing,2018,27(Sup3):S4-S6.
[16]Bajaj J S,Ridlon J M,Hylemon P B,et al.Linkage of gut microbiome with cognition in hepatic encephalopathy[J].American Journal of Physiology Gastrointestinal and Liver Physiology,2012,302(1):168-75.
[17]Janve V S,Hernandez C C,Verdier K M,et al.Epileptic encephalopathy de novo GABRB mutations impair GABAAreceptor function[J].Annals of Neurology,2016,79(5):806-825.
[18]王家珑,李绍白.肝脏病学[M].北京:人民卫生出版社,2013:358-363.
[19]Dhanda S,Gupta S,Halder A,et al.Systemic inflammation without gliosis mediates cognitive deficits through impaired BDNF expression in bile duct ligation model of hepatic encephalopathy[J].Brain Behavior and Immunity,2018,70(5):214-232
[20]Arias N,Méndez M,Alcalde I,et al.Assessing the brain through the eye:New ways to explore hepatic encephalopathy[J].Physiology&Behavior,2017,173(5):263-271.
[21]Arias N,Méndez M,Gómez-Lázaro E,et al.Main target of minimal hepatic encephalopathy:Morphophysiological,inflammatory and metabolic view[J].Physiology&Behavior,2015,149(10):247-254.
[22]Sharon G,Sampson T R,Geschwind D H,et al.The central nervous system and the gut microbiome[J].Cell,2016,167(4):915-932.
[23]Fu Z D,Cui J Y.Remote sensing between liver and intestine:Importance of microbial metabolites[J].Current Pharmacology Reports,2017(3):101-113.
[24]Marshall J C.The gut as a potential trigger of exerciseinduced inflammatory responses[J].Canadian Journal of Physiology and Pharmacology,1998,76(5):479-484.
[25]Sampson T R,Mazmanian S K.Control of brain development,function,and behavior by the microbiome[J].Cell Host Microbe,2015,17(5):565-576.
[26]Williams B B,Van Benschoten A H,Cimermancic P,et al.Discovery and characterization of gut microbiota decarboxylases that can produce the neurotransmitter tryptamine[J].Cell Host Microbe,2014,16(4):495-503.
[27]Holzer P.Neuropeptides,Microbiota,and Behavior[J].Int Rev Neurobiol,2016,131:67-89.
[28]Gareau M G.Cognitive Function and the Microbiome[J].Int Rev Neurobiol,2016,131:227-246.
[29]Frederick RT.Current concepts in the pathophysiology and management of hepatic encephalopathy[J].Gastroenterol Hepatol,2011,7(4):222-233.
[30]LIANG Shuwen,QU Changmin,WANG Xiaoying,et al Clinical research on intestinal flora changes in patients with hepatic encephalopathy[J].J Med Res,2015,44(11):68-70.
[31]Qin J,Li R,Raes J,et al.A human gut microbial gene catalogue established by metagenomic sequencing[J].Nature,2010464(7285):59-65.
[32]杨育林,沈雁,杨法根,等.微生态制剂联合肠内营养治疗肝性脑病的临床研究[J].中国中西医结合消化杂志,2014,22(4):173-177.
[33]朱小区,吴春明,陶玉,等.清腑灌肠方保留灌肠对肝性脑病患者LPS、TNF-α和IL-6的影响[J].中国中医急症,201423(3):389-390.
[34]Wijarnpreecha K,Chesdachai S,Thongprayoon C,et al,Association of helicobacter pylori with the risk of hepatic encephalopathy[J].Dig Dis Sci,2017,62(12):3614-3621.