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肝性脑病(hepatic encephalopathy, HE)是由肝脏功能受到严重障碍和(或)门静脉-体循环分流异常而引发的中枢神经系统(central nervous system, CNS)功能失调的综合征，临床上多以神志精神的异常及代谢的紊乱为主要表现。HE多发病急剧，情况危重，病死率居高不下，由慢性肝病发展为HE的患者，第1年的存活率在50%之下，第3年的死亡率超过75%。目前HE的发病机制尚未完全明确，诸多假说，如氨中毒、代谢紊乱、假性神经递质等，已经过一定的实验论证，可以部分解释HE,但各种假说众说纷纭，隐匿性肝性脑病(covert hepatic encephalopathy, CHE)的最佳治疗和诊断仍在争论中，致使临床治疗方向混乱，治疗方案选择困难，治疗效果不佳。因此，本研究通过总结HE的危险因素，探讨HE新的作用机制、新兴的治疗策略，如CNS清除功能的研究，以及新的治疗靶点，例如肠道菌群移植，从多角度为今后的临床治疗提供一定的理论依据和治疗思路。
Abstract：Hepatic encephalopathy(HE) is a syndrome of central nervous system(CNS) dysfunction caused by severe liver dysfunction and/or abnormal portal vein-systemic shunt. Patients with chronic liver disease to HE have a survival rate of less than 50% in the first year and a mortality rate of more than 75% in the third year. At present, the pathogenesis of HE has not been fully studied, and many hypotheses, such as ammonia poisoning, metabolic disorders, false neurotransmitter etc, have been experimentally demonstrated to some extent, which can partially explain HE, but various hypotheses have different opinions, and the optimal treatment and diagnosis of covert HE(CHE) are still being debated, resulting in confusion in the direction of clinical treatment, difficulty in choosing treatment options, and poor treatment effect. Therefore, by summarizing the risk factors of HE, exploring the new mechanism of action of HE, emerging treatment strategies, such as the study of CNS clearance function, and new therapeutic targets, such as intestinal microbiota transplantation, this study provided a certain theoretical basis and treatment ideas for future clinical treatment from multiple perspectives.
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基本信息:
中图分类号:R575.3
引用信息:
[1]赵婉晴,王宇亮,孙晓娜,等.基于NO/cGMP/PKG信号通路探讨肝性脑病中枢神经系统清除的作用机制及肠道菌群移植治疗进展[J].胃肠病学和肝病学杂志,2026,35(01):10-15.
基金信息:
国家自然科学基金项目(82305074); 河南省中医药拔尖人才培养项目[豫卫中医(2021)15号]
2026-01-20
2026-01-20