Guidelines on the management of hepatic encephalopathy in cirrhosis
-
摘要:
<正>1前言肝性脑病(hepatic encephalopathy,HE)是由急、慢性肝功能严重障碍或各种门静脉-体循环分流(以下简称门-体分流)异常所致的、以代谢紊乱为基础、轻重程度不同的神经精神异常综合征。为了促进HE临床诊疗的规范化,一些国际胃肠和肝病学会陆续发布了HE的指南或共识,对HE的定义及诊疗提出了建议。1998年维也纳第11届世界胃肠病大会(WCOG)成立
-
Key words:
- liver cirrhosis /
- hepatic encephalopathy /
- diagnosis /
- therapy
-
[1]FERENCI P, LOCKWOOD A, MULLEN K, et al.Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification:Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998[J].Hepatology, 2002, 35 (3) :716-721. [2]DHIMAN RK, SARASWAT VA, SHARMA BK, et al.Minimal hepatic encephalopathy:Consensus statement of a working party of the Indian National Association for Study of the Liver[J].J Gastroenterol Hepatol, 2010, 25 (6) :1029-1041. [3]American Association for the Study of Liver Diseases, European Association for the Study of the Liver.Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases[J].J Hepatol, 2014, 61 (3) :642-659. [4] Chinese Society of Gastroenterology and Chinese Society of Hepatology, Chinese Medical Association.Consensus on the diagnosis and treatment of hepatic encephalopathy in China (Chongqing, 2013) [J].Chin J Hepatol, 2013, 21 (9) :641-651. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会.中国肝性脑病诊治共识意见 (2013年, 重庆) [J].中华肝脏病杂志, 2013, 21 (9) :641-651. [5]LIN Y, FAN YP.The neuropsychologic tests and the minimal hepatic encephalopathy investigations in liver cirrhotic patients[J].Chin J Hepatol, 2011, 19 (1) :65-66. (in Chinese) 林言, 范燕萍.肝硬化患者的神经心理测验及轻微肝性脑病调查[J].中华肝脏病杂志, 2011, 19 (1) :65-66. [6]GUO JS.Epidemiology, diagnosis and treatment of minimal hepatic encephalopathy[J].Chin J Hepatol, 2014, 22 (2) :92-93. (in Chinese) 郭津生.重视轻微型肝性脑病的流行病学及诊断与治疗[J].中华肝脏病杂志, 2014, 22 (2) :92-93. [7]BAJAJ JS, O'LEARY JG, TANDON P, et al.Hepatic encephalopathy is associated with mortality in patients with cirrhosis independent of other extrahepatic organ failures[J].Clin Gastroenterol Hepatol, 2017, 15 (4) :565-574.e4. [8]WANG JY, ZHANG NP, CHI BR, et al.Prevalence of minimal hepatic encephalopathy and quality of life evaluations in hospitalized cirrhotic patients in China[J].World J Gastroenterol, 2013, 19 (30) :4984-4991. [9]ALDRIDGE DR, TRANAH EJ, SHAWCROSS DL.Pathogenesis of hepatic encephalopathy:Role of ammonia and systemic inflammation[J].J Clin Exp Hepatol, 2015, 5 (Suppl 1) :s7-s20. [10]LU LG.Hepatic encephalopathy:Not far away from us[J].Chin JDigest, 2017, 37 (8) :508-512. (in Chinese) 陆伦根.肝性脑病:离我们并不遥远[J].中华消化杂志, 2017, 37 (8) :508-512. [11]BAJAJ JS.The role of microbiota in hepatic encephalopathy[J].Gut Microbes, 2014, 5 (3) :397-403. [12]WIJARNPREECHA K, CHESDACHAI S, THONGPRAYOON C, et al.Association of helicobacter pylori with the risk of hepatic encephalopathy[J].Dig Dis Sci, 2017, 62 (12) :3614-3621. [13]BAJAJ JS, RIDLON JM, HYLEMON PB, et al.Linkage of gut microbiome with cognition in hepatic encephalopathy[J].Am J Physiol Gastrointest Liver Physiol, 2012, 302 (1) :g168-g175. [14]JANVE VS, HERNANDEZ CC, VERDIER KM, et al.Epileptic encephalopathy de novo GABRB mutations impair GABAA receptor function[J].Ann Neurol, 2016, 79 (5) :806-825. [15]KOBTAN AA, EL-KALLA FS, SOLIMAN HH, et al.Higher grades and repeated recurrence of hepatic encephalopathy may be related to high serum manganese levels[J].Biol Trace Elem Res, 2016, 169 (2) :153-158. [16]BUTTERWORTH RF.Neurosteroids in hepatic encephalopathy:Novel insights and new therapeutic opportunities[J].J Steroid Biochem Mol Biol, 2016, 160:94-97. [17]PEREIRA K, CARRION AF, MARTIN P, et al.Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy[J].Liver Int, 2015, 35 (12) :2487-2494. [18]TSAI CF, CHEN MH, WANG YP, et al.Proton pump inhibitors increase risk for hepatic encephalopathy in patients with cirrhosis in a population study[J].Gastroenterology, 2017, 152 (1) :134-141. [19]BLEI AT, CRDOBA J.Hepatic encephalopathy[J].Am J Gastroenterol, 2001, 96 (7) :1968-1976. [20]BAJAJ JS, CORDOBA J, MULLEN KD, et al.Review article:The design of clinical trials in hepatic encephalopathy-an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISH-EN) consensus statement[J].Aliment Pharmacol Ther, 2011, 33 (7) :739-747. [21]SHARMA P, SHARMA BC, PURI V, et al.Critical flicker frequency:Diagnostic tool for minimal hepatic encephalopathy[J].JHepatol, 2007, 47 (1) :67-73. [22]AGRAWAL S, UMAPATHY S, DHIMAN RK.Minimal hepatic encephalopathy impairs quality of life[J].J Clin Exp Hepatol, 2015, 5 (Suppl 1) :s42-s48. [23]WANG AJ, PENG AP, LI BM, et al.Natural history of covert hepatic encephalopathy:An observational study of 366 cirrhotic patients[J].World J Gastroenterol, 2017, 23 (34) :6321-6329. [24]LOCKWOOD AH.Blood ammonia levels and hepatic encephalopathy[J].Metab Brain Dis, 2004, 19 (3-4) :345-349. [25]IWASA M, SUGIMOTO R, MIFUJI-MOROKA R, et al.Factors contributing to the development of overt encephalopathy in liver cirrhosis patients[J].Metab Brain Dis, 2016, 31 (5) :1151-1156. [26]HUANG H, WU T, MAO J, et al.CHI3L1 is a liver-enriched, noninvasive biomarker that can be used to stage and diagnose substantial hepatic fibrosis[J].OMICS, 2015, 19 (6) :339-345. [27]YAO M, WANG L, LEUNG PSC, et al.The clinical significance of gp73 in immunologically mediated chronic liver diseases:Experimental data and literature review[J].Clin Rev Allergy Immunol, 2018, 54 (2) :282-294. [28]JEONG JY, JUN DW, BAI D, et al.Validation of a paper and pencil test battery for the diagnosis of minimal hepatic encephalopathy in Korea[J].J Korean Med Sci, 2017, 32 (9) :1484-1490. [29]THOMSEN KL, MACNAUGHTAN J, TRITTO G, et al.Clinical and pathophysiological characteristics of cirrhotic patients with grade1 and minimal hepatic encephalopathy[J].PLo S One, 2016, 11 (1) :e0146076. [30]GIMNEZ-GARZC, GARCS JJ, URIOS A, et al.The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients[J].PLo S One, 2017, 12 (2) :e0171211. [31]HAO LC, HU YQ, HOU XH.Age-and, education-corrected number connection test and digit symbol test in diagnosis of minimal hepatic encephalopathy[J].Chin J Hepatol, 2015, 23 (7) :533-537. (in Chinese) 郝良成, 胡阳黔, 侯晓华.年龄和受教育程度矫正的数字连接测试和数字符号测试在诊断轻肝性脑病中的应用[J].中华肝脏病杂志, 2015, 23 (7) :533-537. [32]WUENSCH T, RUETHER DF, ZLLNER C, et al.Performance characterization of a novel electronic number connection test to detect minimal hepatic encephalopathy in cirrhotic patients[J].Eur JGastroenterol Hepatol, 2017, 29 (4) :456-463. [33]BAJAJ JS, HEUMAN DM, STERLING RK, et al.Validation of encephalapp, smartphone-based stroop test, for the diagnosis of covert hepatic encephalopathy[J].Clin Gastroenterol Hepatol, 2015, 13 (10) :1828-1835.e1. [34]WANG Y, SHI XJ, XIERNAYI ABDHLL, et al.Critical flicker frequency for the diagnosis of minimal hepatic encephalopathy[J].Chin J Hepatol, 2013, 21 (7) :546-547. (in Chinese) 王月, 石绣江, 希尔娜依·阿不都黑力力, 等.临界闪烁频率诊断轻微肝性脑病的价值[J].中华肝脏病杂志, 2013, 21 (7) :546-547. [35]MA QY, ZHUGE YZ.Diagnostic value of critical flicker frequency in minimal hepatic encephalopathy[J].J Clin Hepatol, 2012, 28 (7) :559-561. (in Chinese) 马千云, 诸葛宇征.临界视觉闪烁频率对轻微肝性脑病的诊断价值[J].临床肝胆病杂志, 2012, 28 (7) :559-561. [36]KIRCHEIS G, HILGER N, HUSSINGER D.Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy[J].Gastroenterology, 2014, 146 (4) :961-969. [37]AMPUERO J, SIMN M, MONTOLIU'C, et al.Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis[J].Gastroenterology, 2015, 149 (6) :1483-1489. [38]CAMPAGNA F, MONTAGNESE S, RIDOLA L, et al.The animal naming test:An easy tool for the assessment of hepatic encephalopathy[J].Hepatology, 2017, 66 (1) :198-208. [39]URIOS A, MANGAS-LOSADA A, GIMENEZ-GARZC, et al.Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits[J].Liver Int, 2017, 37 (7) :1013-1022. [40]SEO K, JUN DW, KIM JK, et al.Multi-sensory integration impairment in patients with minimal hepatic encephalopathy[J].Sci Rep, 2017, 7 (1) :14947. [41]GUERIT JM, AMANTINI A, FISCHER C, et al.Neurophysiological investigations of hepatic encephalopathy:ISHEN practice guidelines[J].Liver Int, 2009, 29 (6) :789-796. [42]SHI YB, SENG SJ, GUO M, et al.Magnetic resonance imaging and CT findings of hepatic encephalopathy[J].Chin J Pract Nerv Dis, 2016, 19 (19) :127-127, 128. (in Chinese) 石彦斌, 僧松娟, 郭淼, 等.肝性脑病的磁共振及CT影像表现分析[J].中国实用神经疾病杂志, 2016, 19 (19) :127-127, 128. [43]QI R, ZHANG LJ, ZHONG J, et al.Grey and white matter abnormalities in minimal hepatic encephalopathy:A study combining voxel-based morphometry and tract-based spatial statistics[J].Eur Radiol, 2013, 23 (12) :3370-3378. [44]KALE RA, GUPTA RK, SARASWAT VA, et al.Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy[J].Hepatology, 2006, 43 (4) :698-706. [45]ZHENG G, ZHANG LJ, ZHONG J, et al.Cerebral blood flow measured by arterial-spin labeling MRI:A useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis[J].Eur J Radiol, 2013, 82 (11) :1981-1988. [46]CHEN HJ, CHEN QF, YANG ZT, et al.Aberrant topological organization of the functional brain network associated with prior overt hepatic encephalopathy in cirrhotic patients[J].Brain Imaging Behav, 2018.[Epub ahead of print] [47]CHEN HJ, CHEN QF, LIU J, et al.Aberrant salience network and its functional coupling with default and executive networks in minimal hepatic encephalopathy:A resting-state f MRI study[J].Sci Rep, 2016, 6:27092. [48]JIAO Y, TANG TY, WANG XH, et al.Anterior and posterior default mode networks impairments in minimal hepatic encephalopathy[J].Natl Med J China, 2016, 96 (5) :334-338. (in Chinese) 焦蕴, 汤天宇, 王训恒, 等.轻微型肝性脑病患者前后默认网络改变与神经认知损伤的关系[J].中华医学杂志, 2016, 96 (5) :334-338. [49]SURAWEERA D, SUNDARAM V, SAAB S.Evaluation and management of hepatic encephalopathy:Current status and future directions[J].Gut Liver, 2016, 10 (4) :509-519. [50]SHAWCROSS DL, DUNK AA, JALAN R, et al.How to diagnose and manage hepatic encephalopathy:A consensus statement on roles and responsibilities beyond the liver specialist[J].Eur J Gastroenterol Hepatol, 2016, 28 (2) :146-152. [51]HANAI T, SHIRAKI M, WATANABE S, et al.Sarcopenia predicts minimal hepatic encephalopathy in patients with liver cirrhosis[J].Hepatol Res, 2017, 47 (13) :1359-1367. [52]NESMITH M, AHN J, FLAMM SL.Contemporary understanding and management of overt and covert hepatic encephalopathy[J].Gastroenterol Hepatol (N Y) , 2016, 12 (2) :91-100. [53]YAN M.Selection of the diagnostic and therapeutic methods for minimal hepatic encephalopathy[J].J Clin Hepatol, 2016, 32 (6) :1092-1099. (in Chinese) 阎明.轻微型肝性脑病诊治方法的选择[J].临床肝胆病杂志, 2016, 32 (6) :1092-1099. [54]SCALZO SJ, BOWDEN SC, AMBROSE ML, et al.Wernicke-Korsakoff syndrome not related to alcohol use:A systematic review[J].JNeurol Neurosurg Psychiatry, 2015, 86 (12) :1362-1368. [55]PHAN AQ, PACIFICI M, ESKO JD.Advances in the pathogenesis and possible treatments for multiple hereditary exostoses from the2016 international MHE conference[J].Connect Tissue Res, 2018, 59 (1) :85-98. [56]LIU A, YOO ER, SIDDIQUE O, et al.Hepatic encephalopathy:What the multidisciplinary team can do[J].J Multidiscip Healthc, 2017, 10:113-119. [57]GOYAL O, SIDHU SS, KISHORE H.Minimal hepatic encephalopathy in cirrhosis-how long to treat?[J].Ann Hepatol, 2017, 16 (1) :115-122. [58]DING HG, XU XY, LINGHU EQ, et al.Interpretation of guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :220-222. (in Chinese) 丁惠国, 徐小元, 令狐恩强, 等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].临床肝胆病杂志, 2016, 32 (2) :220-222. [59]Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol, 2017, 33 (10) :1847-1863. (in Chinese) 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志, 2017, 33 (10) :1847-1863. [60]MORATALLA A, AMPUERO J, BELLOT P, et al.Lactulose reduces bacterial DNA translocation, which worsens neurocognitive shape in cirrhotic patients with minimal hepatic encephalopathy[J].Liver Int, 2017, 37 (2) :212-223. [61]SINGH J, SHARMA BC, PURI V, et al.Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy[J].Metab Brain Dis, 2017, 32 (2) :595-605. [62]LAURIDSEN MM, MIKKELSEN S, SVENSSON T, et al.The continuous reaction time test for minimal hepatic encephalopathy validated by a randomized controlled multi-modal intervention-A pilot study[J].PLo S One, 2017, 12 (10) :e0185412. [63]de LORENZO-PINTO A, GARCA-SNCHEZ R, LORENZO-SALINAS A.Lactulose enemas in the treatment of hepatic encephalopathy.Do we help or harm?[J].Rev Esp Enferm Dig, 2017, 109 (10) :736-737. [64]LI LJ, CHEN CL, WU ZW, et al.Effects of Lactitol on intestinal flora and plasma endotoxin in patients with chronic viral hepatitis[J].Chin J Infect Dis, 2005, 23 (6) :395-397. (in Chinese) 李兰娟, 陈春雷, 吴仲文, 等.拉克替醇对慢性病毒性肝炎患者肠道菌群及内毒素血症的影响[J].中华传染病杂志, 2005, 23 (6) :395-397. [65]GONG JS, ZHANG YL, CHEN H.Safety and efficacy of rifaximin versus nonabsorbable disaccharides in treatment of hepatic encephalopathy:A meta analysis[J].Clin Focus, 2015, 30 (2) :191-195. (in Chinese) 龚家顺, 张艳翎, 陈浩.利福昔明与乳果糖、拉克替醇治疗肝性脑病疗效和安全性的Meta分析[J].临床荟萃, 2015, 30 (2) :191-195. [66]GLUUD LL, VILSTRUP H, MORGAN MY.Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis[J].Cochrane Database Syst Rev, 2016, 5:cd003044. [67]BAI M, YANG Z, QI X, et al.L-ornithine-L-aspartate for hepatic encephalopathy in patients with cirrhosis:A meta-analysis of randomized controlled trials[J].J Gastroenterol Hepatol, 2013, 28 (5) :783-792. [68]PRATAP MV, BENJAMIN J, BHUSHAN SM, et al.Effect of probiotic VSL#3 in the treatment of minimal hepatic encephalopathy:Anon-inferiority randomized controlled trial[J].Hepatol Res, 2015, 45 (8) :880-889. [69]SAAB S, SURAWEERA D, AU J, et al.Probiotics are helpful in hepatic encephalopathy:A meta-analysis of randomized trials[J].Liver Int, 2016, 36 (7) :986-993. [70]HU BL, WANG HY, YANG GY.Association of helicobacter pylori infection with hepatic encephalopathy risk:A systematic review[J].Clin Res Hepatol Gastroenterol, 2013, 37 (6) :619-625. [71]SCHULZ C, SCHTTE K, REISENER N, et al.Prevalence of helicobacter pylori infection in patients with minimal hepatic encephalopathy[J].J Gastrointestin Liver Dis, 2016, 25 (2) :191-195. [72]SCHULZ C, SCHTTE K, MALFERTHEINER P.Does H.pylori eradication therapy benefit patients with hepatic encephalopathy?:Systematic review[J].J Clin Gastroenterol, 2014, 48 (6) :491-499. [73]JIANG Q, JIANG G, WELTY TE, et al.Naloxone in the management of hepatic encephalopathy[J].J Clin Pharm Ther, 2010, 35 (3) :333-341. [74]ZOU ZW, ZHONG XN, ZHOU BY, et al.Ornithine aspartate and naloxone combined therapy for hepatic encephalopathy affects cognitive function, prognosis, and neuropeptide levels[J].Chin J Hepatol, 2013, 21 (5) :385-388. (in Chinese) 周泽文, 钟晓妮, 周宝勇, 等.门冬氨酸鸟氨酸联合纳洛酮对肝性脑病患者认知功能和预后及其神经肽类水平的影响[J].中华肝脏病杂志, 2013, 21 (5) :385-388. [75]KHAMAYSI I, WILLIAM N, OLGA A, et al.Sub-clinical hepatic encephalopathy in cirrhotic patients is not aggravated by sedation with propofol compared to midazolam:A randomized controlled study[J].J Hepatol, 2011, 54 (1) :72-77. [76]LACCETTI M, MANES G, UOMO G, et al.Flumazenil in the treatment of acute hepatic encephalopathy in cirrhotic patients:Adouble blind randomized placebo controlled study[J].Dig Liver Dis, 2000, 32 (4) :335-338. [77]ZHAO M, YE DN.Clinical observation on treatment of hepatic cirrhosis complicated with hepatic encephalopathy by integrative chinese and western medicine therapy[J].Res Integrated Tradit Chin Western Med, 2017, 9 (1) :6-8. (in Chinese) 赵敏, 叶丹宁.中西医结合疗法救治肝硬化合并肝性脑病的临床观察[J].中西医结合研究, 2017, 9 (1) :6-8. [78]ZHOU Y, MA YL.Clinicalobservation of“Yangyin Huatan Xifeng Decoction”in the treatment of recurrent hepatic encephalopathy[J].Shanghai J Tradit Chin Med, 2016, 50 (5) :42-44. (in Chinese) 周扬, 马亚丽.养阴化痰息风方治疗反复发作性肝性脑病的临床观察[J].上海中医药杂志, 2016, 50 (5) :42-44. [79]GAN DN, YE YA, JIANG F.Analysis on the preponderant efficacy of traditional chinese medicine to treat minimal hepatic encephalopathy[J].World Chin Med, 2014, 9 (4) :504-506, 509. (in Chinese) 甘大楠, 叶永安, 江锋.对中医药治疗轻微型肝性脑病疗效优势点的分析[J].世界中医药, 2014, 9 (4) :504-506, 509. [80]YAO C, HUANG G, WANG M, et al.Chinese herbal medicine formula Jieduhuayu granules improves cognitive and neurophysiological functions in patients with cirrhosis who have minimal hepatic encephalopathy:A randomized controlled trial[J].Complement T-her Med, 2014, 22 (6) :977-985. [81]GE XJ, ZHAO CQ, XU LM.Effect of Fuzheng Huayu capsules on survival rate of patients with liver cirrhosis[J].Chin J Hepatol, 2017, 25 (11) :834-840. (in Chinese) 戈雪婧, 赵长青, 徐列明.扶正化瘀胶囊对肝硬化患者生存率的影响[J].中华肝脏病杂志, 2017, 25 (11) :834-840. [82]CHI XL, XIAO HM.Traditional Chinese medicine prevention and treatment of liver fibrosis under the new situation of prevention and treatment of viral hepatitis[J].J Clin Hepatol, 2018, 34 (4) :694-697. (in Chinese) 池晓玲, 萧焕明.病毒性肝炎防治新形势下对中医药防治肝纤维化的思考[J].临床肝胆病杂志, 2018, 34 (4) :694-697. [83]LU W, GAO YH, WANG ZZ, et al.Effects of Anluohuaxianwan on transforming growth factor-β1 and related signaling pathways in rats with carbon tetrachloride-induced liver fibrosis[J].Chin JHepatol, 2017, 25 (4) :257-262. (in Chinese) 卢玮, 高玉华, 王珍子, 等.安络化纤丸对肝纤维化大鼠转化生长因子β1及相应信号通路的影响[J].中华肝脏病杂志, 2017, 25 (4) :257-262. [84]WU G, HE HY, LI Y, et al.Clinical effect of combination therapy with Fufang Biejia Ruangan tablet and entecavir in patients with hepatitis B virus-related cirrhosis[J].Chin J Hepatol, 2014, 22 (8) :604-608. (in Chinese) 吴刚, 何鸿雁, 李烨, 等.复方鳖甲软肝片联合恩替卡韦对HBV相关肝硬化患者的临床疗效观察[J].中华肝脏病杂志, 2014, 22 (8) :604-608. [85]KAWAGUCHI T, TANIGUCHI E, SATA M.Effects of oral branchedchain amino acids on hepatic encephalopathy and outcome in patients with liver cirrhosis[J].Nutr Clin Pract, 2013, 28 (5) :580-588. [86]GLUUD LL, DAM G, LES I, et al.Branched-chain amino acids for people with hepatic encephalopathy[J].Cochrane Database Syst Rev, 2017, 5:cd001939. [87]MOUSA N, ABDEL-RAZIK A, ZAHER A, et al.The role of antioxidants and zinc in minimal hepatic encephalopathy:A randomized trial[J].Therap Adv Gastroenterol, 2016, 9 (5) :684-691. [88]HANISH SI, STEIN DM, SCALEA JR, et al.Molecular adsorbent recirculating system effectively replaces hepatic function in severe acute liver failure[J].Ann Surg, 2017, 266 (4) :677-684. [89]SALIBA F, CAMUS C, DURAND F, et al.Albumin dialysis with a noncell artificial liver support device in patients with acute liver failure:A randomized, controlled trial[J].Ann Intern Med, 2013, 159 (8) :522-531. [90]OSMAN MA, SAYED MM, MANSOUR KA, et al.Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients[J].World J Hepatol, 2016, 8 (30) :1279-1286.
本文二维码
计量
- 文章访问数: 3673
- HTML全文浏览量: 157
- PDF下载量: 1338
- 被引次数: 0