PDF(Pubmed)
Abstract：
Brain edema is considered as a common feature associated with hepatic encephalopathy (HE). However, its central role as cause or consequence of HE and its implication in the development of the neurological alterations linked to HE are still under debate. It is now well accepted that type A and type C HE are biologically and clinically different, leading to different manifestations of brain edema. As a result, the findings on brain edema/swelling in type C HE are variable and sometimes controversial. In the light of the changing natural history of liver disease, better description of the clinical trajectory of cirrhosis and understanding of molecular mechanisms of HE, and the role of brain edema as a central component in the pathogenesis of HE is revisited in the current review. Furthermore, this review highlights the main techniques to measure brain edema and their advantages/disadvantages together with an in-depth description of the main ex-vivo/in-vivo findings using cell cultures, animal models and humans with HE. These findings are instrumental in elucidating the role of brain edema in HE and also in designing new multimodal studies by performing in-vivo combined with ex-vivo experiments for a better characterization of brain edema longitudinally and of its role in HE, especially in type C HE where water content changes are small.
摘要：
脑水肿被认为是与肝性脑病（HE）相关的常见特征。然而,它作为HE的原因或结果的核心作用及其在与HE相关的神经系统改变发展中的含义仍在争论中。现在人们普遍认为A型和C型HE在生物学和临床上是不同的，导致脑水肿的不同表现。因此,C型HE中脑水肿/肿胀的发现是可变的，有时存在争议。鉴于肝脏疾病自然史的变化，更好地描述肝硬化的临床轨迹和理解HE的分子机制，而脑水肿作为HE发病机制中的重要组成部分的作用在本综述中被重新审视。此外，这篇综述强调了测量脑水肿的主要技术及其优缺点，并详细描述了使用细胞培养的主要离体/体内发现，动物模型和人类与他。这些发现有助于阐明脑水肿在HE中的作用，也有助于通过进行体内结合离体实验来设计新的多模态研究，以更好地纵向表征脑水肿及其在HE中的作用。尤其是在含水量变化较小的C型HE中。
