Role of ammonia and inflammation in minimal hepatic encephalopathy
Role of ammonia and inflammation in minimal hepatic encephalopathy
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DOI：
10.1007/s11011-006-9042-1
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发表时间：
2007-03-01
影响因子：
3.6
通讯作者：
Jalan, R.
中科院分区：
文献类型：
--
作者：
Shawcross, D. L.;Wright, G.;Jalan, R.
背景：轻度肝性脑病（MHE）在肝硬化中很常见，但其病理生理基础尚不明确。我们评估了MHE的存在是否与肝脏疾病的严重程度、氨水平或炎症的存在相关，并评估了决定高氨血症诱导的神经心理恶化的因素。方法：对84例肝硬化患者进行研究。在用模拟血红蛋白氨基酸组成的溶液（60）或安慰剂（24）诱导高氨血症前后，进行神经心理学测试，并取血检测氨、WCC、CRP、硝酸盐/亚硝酸盐、IL-6和氨基酸。结果：MHE的存在和严重程度与肝脏疾病的严重程度和氨浓度无关，但MHE患者的炎症指标明显高于无MHE患者。在73.3%的患者中，高氨血症诱发>= 1 SD导致一项或多项神经心理测试恶化。这与血浆氨变化的大小和肝脏疾病的严重程度无关，但在炎症更明显的人群中明显更大。结论：我们的数据表明炎症是MHE存在和严重程度的重要决定因素。在炎症较严重的患者中，诱导高氨血症后神经心理功能的改变更大。
Background: Minimal hepatic encephalopathy (MHE) is common in cirrhosis but its pathophysiologic basis remains undefined. We evaluated whether the presence of MHE was associated with severity of liver disease, ammonia levels or the presence of inflammation and assessed factors determining neuropsychological deterioration accompanying induction of hyperammonemia. Methods: Eighty four cirrhotics were studied. A neuropsychological test battery was performed and blood taken for ammonia, WCC, CRP, nitrate/nitrite, IL-6 and amino acids, before and after, induction of hyperammonemia by administration of a solution mimicking the amino acid composition of haemoglobin (60) or placebo (24). Results: The presence and severity of MHE were independent of severity of liver disease and ammonia concentration but markers of inflammation were significantly higher in those with MHE compared with those without. Induction of hyperammonemia produced deterioration in one or more neuropsychological tests by >= 1 SD in 73.3%. This was independent of the magnitude of change in plasma ammonia and severity of liver disease but was significantly greater in those with more marked inflammation. Conclusion: Our data show that inflammation is an important determinant of the presence and severity of MHE. The change in neuropsychological function following induced hyperammonemia is greater in those with more severe inflammation.