中国隐匿性肝性脑病临床诊治专家共识意见

Chinese consensus on clinical diagnosis and management of covert hepatic encephalopathy

隐匿性肝性脑病(CHE)是肝性脑病的重要类型。有别于显性肝性脑病(OHE),CHE患者无定向力障碍、扑翼样震颤等明显临床表现,但存在神经心理学和(或)神经生理学异常,部分患者可出现轻微认知障碍、欣快或焦虑,注意力和计算能力下降。CHE不仅易进展为OHE,还严重影响患者驾驶能力、精细操作能力和健康相关生活质量,增加意外伤害风险,加重家庭和社会负担,缩短肝硬化患者生存期。为进一步提高对CHE的认识,规范CHE诊治,中华医学会消化病学分会组织国内相关领域专家,参考近期国内外相关指南和共识,总结近年来相关领域的研究成果,结合我国实际情况,制定本共识意见。本共识意见就CHE的定义,流行病学,病因、诱因和发病机制,临床表现,诊断和治疗,以及预后和慢病管理形成19项陈述条款,以期为规范国内CHE的诊治提供指导。

Covert hepatic encephalopathy(CHE)is one of the important entities of hepatic encephalopathy.In contrast to patients with overt hepatic encephalopathy(OHE),patients with CHE have no readily identifiable clinical symptoms and signs such as disorientation and asterixis,but have neurocognitive abnormalities detected by neuropsychological and neurophysiological tests.Some patients may experience cognitive impairment,euphoria or anxiety,decreased attention and calculation abilities.CHE is not only prone to develop into OHE,but also has harmful impacts on driving fitness,fine operation ability,and employment,impairs the health-related quality of life,and increases the risk of accidents,resulting in worse financial status and a heavy burden to the family and society and the reduction of the survival of cirrhotic patients.To further deepen the understanding of CHE and standardize its clinical diagnosis and treatment,the Chinese Society of Gastroenterology,Chinese Medical Association organized experts to establish a consensus based on the updated relevant guidelines,experts′consensus,research advance on the diagnosis and treatment of CHE,and clinical practice in China.This consensus contains 19 statements on the definition,epidemiology,etiology,precipitating factors,pathogenesis,clinical manifestations,diagnosis,treatment,prognosis,and chronic disease management of CHE.We aimed to provide the best available evidence to guide clinical practice in the diagnosis and management of patients with CHE.