The Use of Rifaximin in Patients With Cirrhosis.
The Use of Rifaximin in Patients With Cirrhosis.
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利福昔明在肝硬化患者中的应用。
DOI：
10.1002/hep.31708
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Liverhope Consortium
中科院分区：
文献类型：
--
作者：
Caraceni P;Vargas V;Solà E;Alessandria C;de Wit K;Trebicka J;Angeli P;Mookerjee RP;Durand F;Pose E;Krag A;Bajaj JS;Beuers U;Ginès P;Liverhope Consortium
利福昔明是一种口服非全身性抗生素，胃肠道吸收最小，广谱抗菌活性涵盖革兰氏阳性和革兰氏阴性微生物。利福昔明目前在全球范围内用于肝硬化患者预防复发性HE，因为其疗效和安全性已被大型随机临床试验证明。在过去的十年中，实验和临床证据表明，利福昔明可以通过调节肠道微生物组和影响肠肝轴对肝硬化过程产生其他有益作用，这反过来又可以干扰失代偿性肝硬化基础的病理生理级联的主要事件，如全身炎症综合征，门脉高压症和细菌感染。然而，利福昔明用于预防或治疗其他并发症，包括自发性细菌性腹膜炎或其他细菌感染，并不被接受，因为临床试验的证据仍然非常薄弱。本综述在第一部分涉及利福昔明对肝脏疾病致病机制的潜在影响，而在第二部分，其临床效果进行了严格的讨论。显然，由于其对多种致病事件的潜在活性，利福昔明在预防或管理除HE以外的并发症中的功效值得广泛研究。因此，人们迫切期待双盲、充分把握度的随机临床试验的结果，这些试验评估利福昔明单独使用或与其他药物联合使用对硬临床终点的影响，如肝硬化失代偿、慢性急性肝功能衰竭和死亡率。
Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad‐spectrum antibacterial activity covering both gram‐positive and gram‐negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut‐liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The results of double‐blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute‐on‐chronic liver failure, and mortality, are therefore eagerly awaited.
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影响因子：
3.7
作者：
Bajaj JS;Heuman DM;Sanyal AJ;Hylemon PB;Sterling RK;Stravitz RT;Fuchs M;Ridlon JM;Daita K;Monteith P;Noble NA;White MB;Fisher A;Sikaroodi M;Rangwala H;Gillevet PM
通讯作者：
Gillevet PM
交替使用诺氟沙星和利福昔明作为肝硬化腹水患者自发性细菌性腹膜炎一级预防的有效性和安全性：一项前瞻性随机开放标签多中心比较研究
影响因子：
6.6
作者：
Assem, M.;Elsabaawy, M.;El-Azab, G.
通讯作者：
El-Azab, G.
DOI：
10.1097/meg.0000000000001232
发表时间：
2018-10-01
影响因子：
2.1
作者：
Abdel-Razik, Ahmed;Mousa, Nasser;Eldars, Waleed
通讯作者：
Eldars, Waleed
影响因子：
7.6
作者：
Bajaj, Jasmohan S.;O'Leary, Jacqueline G.;Reddy, K. Rajender
通讯作者：
Reddy, K. Rajender
影响因子：
6.7
作者：
Gomez-Hurtado, Isabel;Gimenez, Paula;Such, Jose
通讯作者：
Such, Jose