Current status of rifaximin treatment for hepatic encephalopathy at our hospital

【背景】肝性脳症の原因は主に肝実質機能障害に伴う代謝能低下と門脈圧亢進に伴う門脈-大循環シャントによる.治療の基本となるのはアンモニアを中心とした中毒物質の除去と,アミノ酸などの代謝の是正である.近年,難吸収性抗菌薬であるリファキシミンが使用可能となった.今回我々は,リファキシミンの使用状況,およびその治療効果を検討することとした.【方法】対象は2016年9月から2019年11月までに当院で肝性脳症に対してリファキシミンを投与された60例の肝硬変患者とした.患者背景や肝性脳症に対する有効性と安全性を検討した.【結果】併用薬は分岐鎖アミノ酸製剤(88%),ラクツロース(75%),レボカルニチン製剤(42%),亜鉛製剤(6.7%)であった.カナマイシン硫酸塩からの切り替え症例においても良好な成績が得られていた.血清アンモニア濃度は,リファキシミン投与1ヵ月後にはおよそ半減しており,それ以降も良好なコントロールが得られていた.肝性脳症の再燃はリファキシミン投与開始から100日以内に集中していた.顕在性脳症再燃は高齢者,Child-Pughスコア高値症例,門脈-体循環シャント合併例で多くみられた.【結語】当科におけるリファキシミン投与の現状を調査した結果,肝性脳症に対する有効性と安全性が確認できた.

【Background】Causes of hepatic encephalopathy are mainly due to decreased metabolic capacity associated with hepatic parenchymal dysfunction and portosystemic shunt associated with portal hypertension. The basis of treatment is the removal of toxic substances, mainly ammonia, and the correction of metabolism of amino acids. In recent years, rifaximin, poorly absorbed antibiotics became available. This time, we decided to investigate the use of rifaximin and its therapeutic effects.【Methods】The subjects were 60 cirrhosis patients who received rifaximin for hepatic encephalopathy in our hospital from September 2016 to November 2019. We investigated the efficacy and safety of patients with hepatic encephalopathy. 【Results】Concomitant drugs were branched chain amino acid preparation(88%),lactulose(75%),levocarnitine preparation(42%),and zinc preparation(6.7%).Good results were also obtained in patients switching from kanamycin sulfate. Serum ammonia concentration was approximately halved one month after rifaximin administration, and good control was obtained thereafter. Relapse of hepatic encephalopathy was concentrated within 100 days from the start of rifaximin administration. Overt encephalopathy relapse was more common in the elderly, patients with high Child-Pugh scores, and patients with portosystemic shunt.【Conclusion】The current state of rifaximin administration in our department, the efficacy and safety for hepatic encephalopathy were confirmed.

肝性脳症

肝硬変

予後