肠道微生态与肝性脑病的关系

黄云义; 刘尧; 张群; 时克; 王宪波

doi:10.3969/j.issn.1001-5256.2020.04.045

肠道微生态与肝性脑病的关系

DOI: 10.3969/j.issn.1001-5256.2020.04.045

首都医科大学附属北京地坛医院中西医结合中心

基金项目:

首都卫生发展科研专项(首发2018-1-2172)；北京市医院管理局临床医学发展专项经费资助(ZYLX201707)；北京市科学技术委员会资助(Z191100006619033)；

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中图分类号: R575.3
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出版历程
- 出版日期: 2020-04-20

Association of intestinal microecology with hepatic encephalopathy

Department of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University

Research funding:

摘要

摘要: 肝性脑病(HE)是肝硬化患者常见的一种复杂的神经精神性并发症,具有高发病率、高复发率及高病死率的特点,也是住院和再住院风险增加的一个重要因素。目前对于HE的治疗尚无特效药物,近年来研究发现,肠道微生态变化与HE的发生、发展及预后相关,而且调整肠道菌群对HE有一定的预防性作用。旨在对近年来肠道微生态与HE之间关系的研究进行总结,希望为临床防治HE提供新的治疗思路。
- 胃肠道微生物组 /
- 肝性脑病 /
- 肝硬化
Abstract: Hepatic encephalopathy( HE) is a common and complex neuropsychiatric complication in patients with liver cirrhosis and has the features of high incidence,recurrence,and mortality rates,and it is also an important factor for the increased risk of hospitalization and rehospitalization. At present,there are still no effective drugs for HE. Recent studies have found that intestinal microecological changes are associated with the development,progression,and prognosis of HE,and the regulation of intestinal flora has a certain preventive effect on HE.This article summarizes the research on the association between intestinal microecology and HE in recent years and hopes to provide new ideas for clinical prevention and treatment of HE.
- gastrointestinal microbiome /
- hepatic encephalopathy /
- liver cirrhosis

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参考文献(37)

[1] WU ZW,LI LJ. Liver cirrhosis bacterial infection and intestinal bacterial flora[J]. J Mod Med Health,2019,35(2):161-163.(in Chinese)吴仲文，李兰娟．肝硬化细菌感染与肠道菌群[J]．现代医药卫生，2019,35(2):161-163.

[2] PRASAD S,DHIMAN RK,DUSEJA A,et al. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy[J].Hepatology,2007,45(3):549-559.

[3] OTHMAN M,AGUERO R,LIN HC. Alterations in intestinal microbial flora and human disease[J]. Curr Opin Gastroenterol,2008,24(1):6-11.

[4] SHIMIZU K,OGURA H,GOTO M,et al. Altered gut flora and environment in patients with severe SIRS[J]. J Trauma,2006,60(1):126-133.

[5] WONG F,BERNARDI M,BALK R,et al. Sepsis in cirrhosis:Report on the 7th meeting of the International Ascites Club[J].Gut,2005,54(5):718-725.

[6] SHAWCROSS DL,WRIGHT G,OLDE DAMINK SWM,et al.Role of ammonia and inflammation in minimal hepatic encephalopathy[J]. Metab Brain Dis,2007,22(1):125-138.

[7] HAUSSINGER D,SCHLIESS F. Pathogenetic mechanisms of hepatic encephalopathy[J]. Gut,2008,57(8):1156-1165.

[8] SHAWCROSS DL,SHRIFI Y,CANAVAN JB,et al. Infection and systemic inflammation,not ammonia,are associated with Grade 3/4 hepatic encephalopathy,but not mortality in cirrhosis[J]. J Hepatol,2010,54(4):640-649.

[9] WRIGHT G,JALAN R. Ammonia and inflammation in the pathogenesis of hepatic encephalopathy:Pandora’s box?[J].Hepatology,2007,46(2):291-294.

[10] QIN N,YANG FL,LI A,et al. Alterations of the human gut microbiome in liver cirrhosis[J]. Nature,2014,513(7516):59-64.

[11] BAJAJ JS,HYLEMON PB,RIDLON JM,et al. Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation[J]. Am J Physiol Gastrointest Liver Physiol,2012,303:g675-g685.

[12] JASMOHAN S,BAJAJ JS. The role of microbiota in hepatic encephalopathy[J]. Gut Microbes,2014,5(3):397-403.

[13] MONTGOMERY JY,BAJAJ JS. Advances in the evaluation and management of minimal hepatic encephalopathy[J]. Curr Gastroenterol Rep,2011,13(1):26-33.

[14] MARIA S,ALITA M,CHPY V,et al. In-hospital mortality and economic burden associated with hepatic encephalopathy in the united states from 2005 to 2009[J]. Clin Gastroenterol Hepatol,2012,10(9):1034-1041.

[15] RIORDAN SM,WILLIAMS R. Gut flora and hepatic encephalopathy in patients with cirrhosis[J]. N Engl J Med,2010,362(12):1140-1142.

[16] SHAWCROSS DL,SHARIFI Y,CAVANAN JB,et al. Infection and systemic inflammation,not ammonia,are associated with Grade 3/4 hepatic encephalopathy,but not mortality in cirrhosis[J]. J Hepatol,2011,54(4):640-649.

[17] 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.

[18] ZHANG ZG,ZHAI HQ,GENG JW,et al. Large-scale survey of gut microbiota associated with MHE via 16S rRNA-based pyrosequencing[J]. Am J Gastroenterol,2013,108(10):1601-1611.

[19] NOBLE NA,WHITE MB,MONTEITH P,et al. Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation[J]. Am J Physiol,2012,303(3 Pt 1):g675-g685.

[20] Chinese Society of Hepatology,Chinese Medical Association.Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol,2018,34(10):2076-2089.(in Chinese)中华医学会肝病学分会．肝硬化肝性脑病诊疗指南[J]．临床肝胆病杂志，2018,34(10):2076-2089.

[21] LOKESH J,BARJESH CS,PRAVEEN S,et al. Serum endotoxin and inflammatory mediators in patients with cirrhosis and hepatic encephalopathy[J]. Dig Liver Dis,2012,44(12):1027-1031.

[22] SHARMA BC,SHARMA P,AGRAWAL A,et al. Secondary prophylaxis of hepatic encephalopathy:An open-label randomized controlled trial of lactulose versus placebo[J]. Gastroenterology,2009,137(3):885-891.

[23] BASS NM,MULLEN KD,SANYAL A,et al. Rifaximin treatment in hepatic encephalopathy[J]. N Engl J Med,2010,362(12):1071-1081.

[24] TAKUMI K,FUMITAKA S,MASATOSHI I,et al. Rifaximin-altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy:An exploratory data analysis of phase II/III clinical trials[J]. Hepatol Res,2019,49(4):404-418.

[25] BAJAJ JS,HEUMAN DM,HYLEMON PB,et al. Randomised clinical trial:Lactobacillus GG modulates gut microbiome,metabolome and endotoxemia in patients with cirrhosis[J]. Aliment Pharmacol Ther,2014,39(10):1113-1125.

[26] MILLION M,MARANINCHI M,HENRY M,et al. Obesity-associated gut microbiota is enriched in Lactobacillus reuteri and depleted in Bifidobacterium animalis and Methanobrevibacter smithii[J]. Int J Obes,2012,36(6):817-825.

[27] ELSHAGHABEE-FOUAD MF,BOCKELMANN W,MESKE D,et al. Ethanol production by selected intestinal microorganisms and lactic acid bacteria growing under different nutritional conditions[J]. Front Microbiol,2016,7(7):1-13.

[28] MARLICZ W,WUNSCH E,MYDLOWSKA M,et al. The effect of short term treatment with probiotic VSL#3 on various clinical and biochemical parameters in patients with liver cirrhosis[J].J Physiol Pharmacol,2016,67(6):867-877.

[29] SAMMY S,DUMINDA S,JENNIFER A,et al. Probiotics are helpful in hepatic encephalopathy:A meta-analysis of randomized trials[J]. Liver Int,2016,36(7):986-993.

[30] SHAVAKHI A,HASHEMI H,TABESH E,et al. Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy[J]. J Res Med Sci,2014,19(8):703-708.

[31] KAPIL S,SANJAY P,SRIPHAKASH M,et al. Effect of rifaximin,probiotics,and l-ornithine l-aspartate on minimal hepatic encephalopathy:A randomized controlled trial[J]. Saudi J Gastroenterol,2014,20(4):225.

[32] SHULIA S,MAHL TC,GUHA S. Letter:Probiotics vs. lactulose for minimal hepatic encephalopathy therapy—authors’reply[J]. Aliment pharmacol Ther,2014,39(9):1000.

[33] VIRAMONTES HD,AVERY A,STOW R. The Effects of probiotics and symbiotics on risk factors for hepatic encephalopathy:A systematic review[J]. J Clin Gastroenterol,2017,51(4):312-323.

[34] OWENS C,BROUSSARD E,SURAWICZ C. Fecal microbiota transplantation and donor standardization[J]. Trends Microbiol,2013,21(9):443-445.

[35] BAJAJ JS,KASSAM Z,FAGAN A,et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy:A randomized clinical trial[J]. Hepatology,2017,66(6):1727-1738.

[36] TANDON P,MADSEN K,KAO D. Fecal microbiota transplantation for hepatic encephalopathy:Ready for prime time?[J].Hepatology,2017,66(6):1713-1715.

[37] JACOB V,CRAWFORD C,COHEN-MEKEBURG S,et al.Single delivery of high-diversity fecal microbiota preparation by colonoscopy is safe and effective in increasing microbial diversity in active ulcerative colitis[J]. Inflamm Bowel Dis,2017,23(6):903-911.

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