Myth: interpretation of a single ammonia level in patients with chronic liver disease can confirm or rule out hepatic encephalopathy.
Myth: interpretation of a single ammonia level in patients with chronic liver disease can confirm or rule out hepatic encephalopathy.
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误区：解释慢性肝病患者的单一氨水平可以确诊或排除肝性脑病。
DOI：
10.1017/s148180350001424x
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
M. Herbert
中科院分区：
文献类型：
--
作者：
S. Arora;Christopher L. Martin;M. Herbert
尽管肝性脑病（HE）的确切病理生理学尚不完全清楚，但一个多世纪以来，氨一直被认为起着关键作用。然而，对以HE为表现的慢性肝病（CLD）患者氨水平的解释和应用一直是一个长期存在的困惑来源。在急诊科和病房中，人们普遍认为，CLD患者单次氨水平升高就可以确诊为HE，而正常水平则基本上可以排除HE。这种混淆源于这样一个事实，即早期研究表明脑病程度与氨水平之间存在相关性，但随后的大量研究表明，严重脑病患者通常氨水平正常。本文回顾了已发表的关于CLD患者氨水平的文献，试图阐明其作为疑似HE患者临床决策工具的价值。
Although the exact pathophysiology of hepatic encephalopathy (HE) is not fully understood, for more than a century ammonia has been thought to play a critical role. However, the interpretation and utility of ammonia levels in patients with chronic liver disease (CLD) presenting with HE has been a long-standing source of confusion. It is a common belief in the emergency department and on the wards that a single elevated ammonia level in a patient with CLD can confirm the diagnosis of HE, and a normal level essentially rules it out. This confusion stems from the fact that early studies showed a correlation between degree of encephalopathy and the ammonia level, but numerous subsequent studies have shown that severely encephalopathic patients often have normal ammonia levels. This paper reviews the published literature on ammonia levels in patients with CLD in an attempt to clarify its value as a clinical decision-making tool in patients with suspected HE.