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withoutsun铜虫 (小有名气)
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[求助]
求助翻译肝性脑病相关文献~！！！
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We treated a 57-year-old man suffering from grade 1-2 HE with liver cirrhosis (Model for End-Stage LiverDisease score510) secondary to alcohol and hepatitisC. He had previously responded well to lactulose andrifaximin but could no longer afford rifaximin when Health Canada ended its compassionate release program. His subjective baseline assessment by his caregivers and health care team found him lethargic, with sleep-wake cycle reversal, slow reaction time, and intermittent disorientation for time. After obtaining informed consent, he was given five weekly FMTs from a universal stool donor registered with our FMT program, the first administered by colonoscopy and the remaining four by retention enema. Subjective and objective changes in mental status were assessed weekly, including use of the inhibitory control test (ICT) and the Stroop test. Random serum ammonia levels were measured at each visit. The patient was instructed to keep his diet and lactulose dose similar during the study. Within the first week of treatment, objective measures of reaction time, Stoop test, serum ammonia, and quality of life all significantly improved. Subjectively the patient reported improved appetite, alertness, and overall well-being. Unfortunately, he missed his second FMT, and these parameters deteriorated. Following further FMT, he continued to improve as he becamemore alert, with better ability to concentrate and follow instructions and improved sleep–wake cycle. All of these changes were noted by the study team and corroborated by his caregivers. Objectively, his ICTand Stroop test scores normalized by week 4. The patient unfortunately developed gallstone pancreatitis and required hospitalization for pain control at week 10, when he was noticeably more encephalopathic. By week 14, his ICT and Stroop scores had reverted to baseline. Table 1 summarizes the changes in ICT, Stroop test, and random serum ammonia levels in relation to FMT. No adverse events or infectious complications related to FMT occurred. |
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