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1、•文献综述•轻微肝性脑病的诊断和治疗进展王芳,吕洪敏ProgressindiagnosisandtreatmentstudyofminimalhepaticencephalopathyFangWang,Hong-MinLvFangWang,Hong-MinLv,DepartmentofGastroenterology,TianjinThirdCentralHospital,Tianjin300170,ChinaCorrespondenceto:Hong-MinLv,DepartmentofGastro
2、enterology,TianjinThirdCentralHospital,Tianjin300170,Chinayaoywang@163.comChinaisabigcountrywithchronicliverdisease,theincidenceofminimalhepaticencephalopathy(MHE)incirrhoticpatientsisveryhigh.Duetothelackofobviouslyabnormalbehaviorandmentaldisorderofhe
3、paticencephalopathy,patientswithMHEarenoteasilyfoundindailylifeandimpairtheirdailyfunctioning.Especiallywhenthoseareengagedinhigh-altitudeoperationsormechanicaldrivers,theyareaccident-prone.MHEcanpredictsthedevelopmentofoverthepaticencephalopathy.Withth
4、eimprovementofpeople'sstandardofliving,Chinahasgraduallyincreasedtheproportionofdrivers,theinfluenceofMHEondrivealsomoreandmorereceivespeople'sattention.AtpresenttherearenostandardonthediagnosisandtreatmentprogrammesofMHE.Traditionaldiagnosticandtherape
5、uticmethodsonMHEincludingtheuseofnumberconnectiontests(NCT),digitsymboltest(DST)andtheuseoflactulosetherapy.Recently,theinhibitorycontroltest(ICT)andprobioticstreatmentofMHEreceiveeverybodysattention.ThispaperontherecentMHEinthediagnosisandtreatmentofpr
6、ogressforabriefoverview・KeyWords:minimalhepaticencephalopathy王芳,吕洪敏,天津市第三中心医院消化内科天津市河东区300170通讯作者:吕洪敏,300170,夭津市,天津市第三屮心医院消化内科.yaoywang@163.com电话:022-84112167传真:无摘要我国是慢性肝病大国,轻微肝性脑病(MHE)在肝硬化病人屮发病率很高。因没有明显肝性脑病的行为异常及精神错乱,MHE患者在日常生活中不易被发现,但生活质量受到影响,尤其是从事髙空作
7、业或机械驾驶者容易发生意外,并H可以预示临床肝性脑病的发生。随着人们生活水平的提高,我国自驾车人比例逐渐上升,MHE对于驾车的影响也越来越受到人们的关注。目前关于MHE还没有规范统一的诊断和治疗方案。传统的MHE诊疗方法包括采用数字连接试验、数字符号试验等手段来检测,多采用乳果糖治疗。新近,抑制控制试验和微生态制剂诊治MHE受到人家的关注。木文拟对近期MHE在诊断和治疗方面的进展作一简要综述。关键词:轻微肝性脑病0引言1978年Rikklers等提出亚临床肝性脑病(SubclinicalHepatic
8、Encephalopathy,SHE)的概念,随后国内外的学者对肝便化患者进行了大量关于MHE的研究。研究认为SHE是指各种肝硬化病人无临床精神状态及神经系统检杏的异常,仅能用精细的智力测验和/或神经电生理检测叮见智力或神经、精神缺陷才能诊断的肝性脑病。因SHE易被误认为发病机制独立于HEZ外或临床意义不大,故而口1998年第11届世界胃肠会议Z后,国内外学者已建议将亚临床肝性脑病更名为轻微肝性脑病(MinimalHepaticEncephalopath