基于肠道菌群下肝性脑病的发病机制及治疗

Pathogenesis and treatment of hepatic encephalopathy based on intestinal microbiota

肝性脑病是肝硬化的常见并发症,以认知功能障碍及神经系统体征异常为主要临床表现,病死率较高。目前肝性脑病的发病机制仍不明确,缺乏特异性治疗方案。肝性脑病患者肠道微生态系统失调,并可能通过促进血氨产生、炎症因子释放、影响神经递质产生、减少胆汁酸及短链脂肪酸合成等机制诱发肝性脑病。因此,基于肠道菌群的肝性脑病治疗成为新的切入点,包括益生菌、益生元、抗生素的使用及粪菌移植。本文总结肠道菌群在肝性脑病中的主要作用机制及基于肠道菌群的相关治疗,以期为临床治疗肝性脑病提供新的理论依据。

Hepatic encephalopathy is a common complication of liver cirrhosis.Cognitive dysfunction and abnormal signs of nervous system are the main clinical manifestations,and the fatality rate is relatively high.Currently,the pathogenesis of hepatic encephalopathy is still unclear and specific treatment is lacking.The intestinal microecosystem of patients with hepatic encephalopathy is dysfunctional,and it may induce hepatic encephalopathy by promoting the production of blood ammonia,releasing inflammatory factors,affecting the production of neurotransmitters,and reducing the synthesis of bile acids and short-chain fatty acids.Therefore,the treatment of hepatic encephalopathy based on intestinal flora has become a new entry point,including the use of probiotics,prebiotics,and antibiotics and fecal microbiota transplantation.This review summarizes the main mechanism of action of intestinal flora in hepatic encephalopathy and related treatments based on intestinal flora,in order to provide a new theoretical basis for clinical treatment of hepatic encephalopathy.