~
検索条件をクリア

アブストラクト

Title 3. 肝性脳症の診断と薬物治療
Subtitle 特集 肝硬変のトータルマネジメント
Authors 遠藤啓, 滝川康裕
Authors (kana)
Organization 岩手医科大学消化器内科肝臓分野
Journal 肝臓クリニカルアップデート
Volume 6
Number 2
Page 151-154
Year/Month 2020 / 10
Article 報告
Publisher 医学図書出版
Abstract 「要旨」肝性脳症は肝不全に起因した肝の解毒・代謝能低下あるいは門脈大循環短絡により, 神経毒性物質が大循環に流入することにより引き起こされた脳機能障害である. 不顕性から昏睡まで幅広い精神・神経異常をきたし, 生命予後のみならず生活の質を悪化させるため, 正確な診断と治療を要する. 肝性脳症の治療は誘因・増悪因子の是正が治療の基本となる. 合成二糖類に加えて, 難吸収性抗菌薬であるリファキシミンや亜鉛・L-カルニチンの補充療法も効果が期待されている.
Practice 臨床医学:内科系
Keywords 肝性脳症, ミニマル肝性脳症, リファキシミン
  • 全文ダウンロード: 従量制、基本料金制の方共に1,023円(税込) です。

参考文献

  • 1) Bajaj JS : Minimal hepatic encephalopathy mat-ters in daily life. World J Gastroenterol 14 : 3609-3615, 2008
  • 2) Stewart CA, Malinchoc M, Kim WR, et al : He-patic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl 13 : 1366-1371, 2007
  • 3) Lockwood AH, Yap EW, Wong WH, et al : Cere-bral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 11 : 337-341, 1991
  • 4) Cordoba J, Alonso J, Rovira A, et al : The devel-opment of low-grade cerebral edema in cirrhosis is supported by the evolution (1) H-magnetic resonance abnormalities after liver transplanta-tion. J Hepatol 35 : 598-604, 2001
  • 5) Ebadi M, Bhanji RA, Mazurak VC, et al : Sarco-penia in cirrhosis : from pathogenesis to inter-ventions. J Gastroenterol 54 : 845-859, 2019
残りの14件を表示する
  • 6) Dharel N, Bajaj JS : Definition and nomenclature of hepatic encephalopathy. J Clin Exp Hepatol 5 : S37-41, 2015
  • 7) Kato A, Tanaka H, Kawaguchi T, et al : Nutri-tional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis : a prelimi-nary, prospective, open-label study. Hepatol Res 43 : 452-458, 2013
  • 8) Groeneweg M, Quero JC, De Bruijn I, et al : Sub-clinical hepatic encephalopathy impairs daily functioning. Hepatology 28 : 45-49, 1998
  • 9) Kawaguchi T, Konishi M, Kato A, et al : Updating the neuropsychological test system in Japan for the elderly and in a modern touch screen tablet society by resetting the cut-off values. Hepatol Res 47 : 1335-1339, 2017
  • 10) Bajaj JS, Heuman DM, Sterling RK, et al : Valida-tion of EncephalApp, smartphone-based stroop test, for the diagnosis of covert hepatic encepha-lopathy. Clin Gastroenterol Hepatol 13 : 1828-1835, 2015
  • 11) Kooka Y, Sawara K, Endo R, et al : Brain metabo-lism in minimal hepatic encephalopathy assessed by 3.0-Tesla magnetic resonance spectroscopy. Hepatol Res 46 : 269-276, 2016
  • 12) Sato T, Endo K, Kakisaka K, et al : Decreased mean kurtosis in the putamen is a diagnostic feature of minimal hepatic encephalopathy in patients with cirrhosis. Intern Med 58 : 1217-1224, 2019
  • 13) Gluud LL, Vilstrup H, Morgan MY : Non-absorb-able disaccharides versus placebo/no interven-tion and lactulose versus lactitol for the preven-tion and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev CD003044, 2016
  • 14) Bajaj JS, Sanyal AJ, Bell D, et al : Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients. Aliment Pharmacol Ther 31 : 1012-1017, 2010
  • 15) Bass NM, Mullen KD, Sanyal A, et al : Rifaximin treatment in hepatic encephalopathy. N Engl J Med 362 : 1071-1081, 2010
  • 16) Sharma BC, Sharma P, Lunia MK, et al : A ran-domized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol 108 : 1458-1463, 2013
  • 17) Mullen KD, Sanyal AJ, Bass NM, et al : Rifaximin is safe and well tolerated for long-term mainte-nance of remission from overt hepatic encepha-lopathy. Clin Gastroenterol Hepatol 12 : 1390-1397, 2014
  • 18) Riggio O, Merli M, Capocaccia L, et al : Zinc supplementation reduces blood ammonia and in-creases liver ornithine transcarbamylase activity in experimental cirrhosis. Hepatology 16 : 785-789, 1992
  • 19) Jiang Q, Jiang G, Shi KQ, et al : Oral acetyl-L-carnitine treatment in hepatic encephalopathy : view of evidence-based medicine. Ann Hepatol 12 : 803-809, 2013