肝病中的氨:争议与共识一瞥。

IF 1.1 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Arab Journal of Gastroenterology Pub Date : 2024-09-17 DOI:10.1016/j.ajg.2024.07.016
George Sarin Zacharia, Anu Jacob
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引用次数: 0

摘要

氨是含氮微分子和大分子新陈代谢的副产物。人体内氨的主要来源是小肠,来自饮食、肠腔细菌活动和肠细胞中谷氨酰胺的脱氨作用。氨主要通过尿素循环从肝脏排出体外。在生理上,氨在酸碱平衡中的作用很小。它是肝性脑病发病机制中的关键分子。肝脏疾病是导致高氨血症的最常见原因,其他原因包括尿素循环缺陷、感染和药物。氨在肝病中的诊断效用受到越来越多的质疑,但在尿素循环缺陷中的诊断效用却很好。此外,氨检测的准确性还取决于患者和技术方面的诸多因素,因此,如果不仔细操作,检测结果并不可靠。目前,大多数科学协会都不建议将氨用于慢性肝病的诊断。尽管如此,氨仍然是疑似肝性脑病患者最常要求检测的项目之一,造成了大量的非生产性医疗支出。然而,氨水平确实对肝病,尤其是急性肝衰竭有预后作用。降氨策略是治疗肝性脑病的基石。这些策略包括减少氨生成的药物和氨清除剂。本综述探讨了氨在肝性脑病中的作用、氨对肝病诊断和预后的影响、与氨检测相关的挑战以及目前临床实践中的降氨治疗策略。
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Ammonia in liver diseases: A glimpse into the controversies and consensus.

Ammonia is a byproduct of the metabolism of nitrogen-containing micro and macromolecules. The key source of bodily ammonia in humans is the small intestine, from diet, luminal bacterial activity, and deamination of glutamine in enterocytes. It is disposed of from the system, mainly in the liver, through the urea cycle. Physiologically, ammonia plays a minor role in acid-base homeostasis. It is the critical molecule implicated in the pathogenesis of hepatic encephalopathy. Liver disease is the most common cause of hyperammonemia, while others include urea cycle defects, infections, and drugs. The diagnostic utility of ammonia in liver diseases has met with increasing skepticism but holds good in urea cycle defects. Additionally, the accuracy of ammonia assay depends on a myriad of patient and technical factors, making the test unreliable if not performed meticulously. Most scientific societies currently fall short of recommending ammonia for diagnostic purposes in chronic liver disease. Despite this fact, ammonia continues to be one of the most frequently requested assays in patients with suspected hepatic encephalopathy, contributing to significant non-productive health expenditure. However, ammonia level does have a prognostic role in liver diseases, especially in acute liver failure. Ammonia-lowering strategies are the cornerstone of the management of hepatic encephalopathy. These strategies include medications that attenuate ammoniagenesis and ammonia scavengers. This review examines the role of ammonia in hepatic encephalopathy, its diagnostic and prognostic implications in liver diseases, challenges associated with ammonia assay, and current therapeutic strategies for ammonia-lowering in clinical practice.

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来源期刊
Arab Journal of Gastroenterology
Arab Journal of Gastroenterology Medicine-Gastroenterology
CiteScore
2.70
自引率
0.00%
发文量
52
期刊介绍: Arab Journal of Gastroenterology (AJG) publishes different studies related to the digestive system. It aims to be the foremost scientific peer reviewed journal encompassing diverse studies related to the digestive system and its disorders, and serving the Pan-Arab and wider community working on gastrointestinal disorders.
期刊最新文献
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