Introduction
Minimal hepatic encephalopathy (MHE) represents the earliest and mildest form of hepatic encephalopathy. MHE does not represent clinically significant neurological and psychiatric abnormalities, and cognitive dysfunction is detected only with neuropsychological testing. Early diagnosis of HE is a prerequisite for maintaining the quality of life of patients and preventing overt HE.
Aims & Methods
Purpose of the study.To compare the dynamics of clinical and laboratory data and evaluate the incidence of complications during 3 months of follow-up with or without rifaximin-α therapy in patients with MHE associated with liver cirrhosis (LC).
Materials and research methods. Patients were selected according to the inclusion criteria: age from 18 to 75 years, the presence of cirrhosis (regardless of severity on the Child-Pugh scale), the presence of MHE, and signed voluntary informed consent. In total, the study included 40 patients with MHE against the background of cirrhosis of various etiology and severity according to the Child-Pugh scale (A-C). Depending on the MHE treatment regimen, patients were randomly divided into groups: group 1 (n=14; 35%) - permanent therapy with rifaximin-α at a dose of 1200 mg/day, group 2 (n=12; 30%) - course rifaximin-α therapy at a dose of 1200 mg/day in courses (7 days of each month), group 3 (n=14; 35%) - without rifaximin-α therapy. Patients underwent an analysis of clinical (assessment of the severity of hepatic encephalopathy according to the results of psychometric tests: a number connection test, an animal name test-ANT, a short scale for assessing mental status-MMSE) and laboratory data (clinical and biochemical analysis, blood, coagulogram, capillary blood ammonia level), and also assessment of the quality of life (questionnaire-SF36) at the beginning of the study and after 3 months of observation.
Results
According to the results of the study, in group 1, against the background of constant therapy with rifaximin-α, 85.7% (n=12) showed a decrease in the level of ammonia in capillary blood, 28.5% (n=4) showed regression of MHE according to the results of psychometric tests, 71.4% (n=10) improved their quality of life. At the same time, 21.4% (n=3) had progression of MHE to overt HE, 21.4% (n=3) had an increase in the level of ammonia in capillary blood, 14,2% (n=2) had infectious complications (sinusitis, otitis media, ARI). In group 2, with the course use of rifaximin-α, 100% (n=12) showed a decrease in the level of ammonia in capillary blood, 16,6% (n=2) showed regression of MHE in the form of an improvement in psychometric tests, and 58,3% (n=7) showed an improvement in the quality of life. It should be noted that 8,3% (n=1) were diagnosed with the addition of a new coronavirus infection, as well as 8,3% (n=1) had bleeding from the esophageal varices. In group 3, 42.8% (n=6) showed a deterioration in the course of MHE, in the form of its progression to overt HE, 50% (n=7) showed an increase in ammonia levels, 64.2% (n=9) deteriorating quality of life indicators. In addition, 14,2% (n=2) were diagnosed with bleeding from the esophageal varices with a fatal outcome.
Conclusion
The study found that rifaximin-α reduces the progression of MHE to overt HE, the progression of portal hypertension, and also improves the quality of life in patients of this category. When comparing the effectiveness of continuous and course therapy with rifaximin-α, the results did not show significant differences, so further studies are needed in patients with cirrhosis and MHE to improve diagnostic and treatment approaches in patients of this category.
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