Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonemia in cirrhosis
Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonemia in cirrhosis
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DOI：
10.1016/j.jhep.2003.10.016
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发表时间：
2004-02-01
影响因子：
25.7
通讯作者：
Jalan, R
中科院分区：
文献类型：
--
作者：
Shawcross, DL;Davies, NA;Jalan, R
背景/目标：急性肝功能衰竭的研究表明，全身炎症反应综合征（SIRS）与肝性脑病（HE）进展之间存在相关性。我们测试的假设，SIRS介质，如一氧化氮和促炎细胞因子，可能会加剧高血氨症在cirrhosis.Methods的神经心理学影响：10例肝硬化患者进行了研究，24-36小时后入院的临床感染的证据，并按照其决议。通过口服模拟血红蛋白组成的氨基酸（aa）溶液诱导高氨血症。炎症介质，硝酸盐/亚硝酸盐，氨，AA配置文件和电池的神经心理tests.Results：响应AA溶液中产生的高氨血症是相似的之前，和之后的决议，炎症（P = 0.77）。感染治疗后，白色血细胞计数（WBC）、C反应蛋白（CRP）、硝酸盐/亚硝酸盐、白细胞介素-6、白细胞介素-1 β和肿瘤坏死因子α显著降低。诱导高血氨导致显着恶化的神经心理学评分时，患者表现出SIRS的证据，但不是在其resolution.Conclusions：显着恶化的神经心理学测试分数诱导高血氨在炎症状态下，但不是在其决议后，表明炎症及其介质可能是重要的调节脑效应的氨在肝脏疾病。(C)2003年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background/Aims: Studies in acute liver failure show correlation between evidence of a systemic inflammatory response syndrome (SIRS) and progression of hepatic encephalopathy (HE). We tested the hypothesis that SIRS mediators, such as nitric oxide and proinflammatory cytokines, may exacerbate the neuropsychological effects of hyperammonemia in cirrhosis.Methods: Ten patients with cirrhosis were studied, 24-36 h after admission with clinical evidence of infection, and following its resolution. Hyperammonemia was induced by oral administration of an amino-acid (aa) solution mimicking hemoglobin composition. Inflammatory mediators, nitrate/nitrite, ammonia, aa profiles and a battery of neuropsychological tests were measured.Results: The hyperammonemia generated in response to the aa solution was similar prior to, and after resolution, of the inflammation (P = 0.77). With treatment of the infection there were significant reductions in white blood cell count (WBC), C-reactive protein (CRP), nitrate/nitrite, interleukin-6, interieukin-1beta and tumour necrosis factor alpha. Induced hyperammonemia resulted in significant worsening of the neuropsychological scores when patients showed evidence of SIRS but not after its resolution.Conclusions: The significant deterioration of neuropsychological test scores following induced hyperammonemia during the inflammatory state, but not after its resolution, suggests that the inflammation and its mediators may be important in modulating the cerebral effect of ammonia in liver disease. (C) 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.