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首页> 外文期刊>The annals of pharmacotherapy >Combination therapy for the treatment and prevention of hepatic encephalopathy [Terapia combinada para el tratamiento y prevención de la encefalopatía hepática]
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Combination therapy for the treatment and prevention of hepatic encephalopathy [Terapia combinada para el tratamiento y prevención de la encefalopatía hepática]

机译：肝性脑病的综合治疗和预防[肝性脑病的综合治疗和预防]

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OBJECTIVE: To evaluate the efficacy and safety of combination therapy for the treatment and prevention of hepatic encephalopathy (HE). DATA SOURCES: A PubMed MEDLINE search was conducted (1947-June 2012) using the key terms lactulose, lactitol, nonabsorbable disaccharide, metronidazole, rifaximin, neomycin, probiotics, and hepatic encephalopathy. Searches were limited to include articles published in English. STUDY SELECTION AND DATA EXTRACTION: Study selection included published trials, case reports, and case series of humans with HE who were treated with combination therapy of rifaximin, lactulose, lactitol, metronidazole, neomycin, and/or probiotics. DATA SYNTHESIS: Only 6 studies that evaluated the benefits of combination drug therapy in the treatment or prevention of HE were available for review. Four studies addressed the treatment of HE, 2 found no significant difference between lactulose/ neomycin versus placebo or rifaximin/lactulose, 1 assessed the use of rifaximin/ lactulose without a control group, and the fourth found no significant difference between lactulose/probiotics versus either drug alone, although each group showed improvement from baseline. In the 2 prevention trials, both of which stemmed from the same data, the combination of rifaximin/lactulose was superior to lactulose alone, showing significant improvement in mental status, blood ammonia levels, and health-related quality of life and reductions in HE recurrence and hospitalization. Currently, there are no available clinical studies evaluating dual antibiotic therapy, metronidazole with nonabsorbable disaccharides, or antibiotics with probiotics. CONCLUSIONS: The evidence evaluating the use of combination therapy for the treatment of HE does not support its widespread use. The combination of rifaximin and lactulose may be considered in the treatment of HE and in patients refractory to monotherapy. The combination of rifaximin and lactulose should be considered for the prevention of HE, especially after the second episode of HE recurrence.
机译：目的：评价联合治疗肝性脑病（HE）的疗效和安全性。数据来源：使用关键词乳果糖，乳糖醇，不可吸收的二糖，甲硝唑，利福昔明，新霉素，益生菌和肝性脑病进行了PubMed MEDLINE搜索（1947年6月至2012年6月）。搜索仅限于以英文发表的文章。研究选择和数据提取：研究选择包括已发表的试验，病例报告和一系列人，这些人接受了利福昔明，乳果糖，乳糖醇，甲硝唑，新霉素和/或益生菌的联合治疗。数据综合：仅6项评估联合药物治疗在HE治疗或预防中的益处的研究可供审查。有4项研究针对HE的治疗，有2项发现乳果糖/新霉素与安慰剂或利福昔明/乳果糖之间无显着差异，有1项评估了无对照组的利福昔明/乳果糖的使用情况，第4项发现乳果糖/益生菌与任一组之间无显着差异单独使用药物，尽管各组均较基线水平有所改善。在两项基于相同数据的预防性试验中，利福昔明/乳果糖的组合优于单独的乳果糖，显示出精神状态，血氨水平和健康相关生活质量的显着改善，并且HE复发率降低和住院。目前，尚无可用于评估双重抗生素疗法，甲硝唑与不可吸收的二糖或抗生素与益生菌的临床研究。结论：评估联合疗法治疗HE的证据并不支持其广泛使用。利福昔明和乳果糖的组合可用于治疗HE和难于单一治疗的患者。应考虑利福昔明和乳果糖的组合预防HE，尤其是在HE复发第二次后。

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