Hepatic encephalopathy (HE) is a complication of cirrhosis characterised by neuropsychiatric and motor dysfunction. Microbiota-host interactions play an important role in HE pathogenesis. Therapies targeting microbial community composition and function have been explored for the treatment of HE. Prebiotics, probiotics and faecal microbiota transplant (FMT) have been used with the aim of increasing the abundance of potentially beneficial taxa, while antibiotics have been used to decrease the abundance of potentially harmful taxa. Other microbiome therapeutics, including postbiotics and absorbents, have been used to target microbial products. Microbiome-targeted therapies for HE have had some success, notably lactulose and rifaximin, with probiotics and FMT also showing promise. However, there remain several challenges to the effective application of microbiome therapeutics in HE, including the resilience of the microbiome to sustainable change and unpredictable clinical outcomes from microbiota alterations. Future work in this space should focus on rigorous trial design, microbiome therapy selection, and a personalised approach to HE.

肝性脑病（HE）是肝硬化的一种并发症，其特征是神经精神和运动功能障碍。微生物群与宿主的相互作用在 HE 发病机制中发挥着重要作用。针对 HE 的治疗，已经探索了针对微生物群落组成和功能的疗法。益生元、益生菌和粪便微生物移植 (FMT) 的目的是增加潜在有益类群的丰度，而抗生素则用于减少潜在有害类群的丰度。其他微生物组疗法，包括后生元和吸收剂，已被用于针对微生物产品。针对 HE 的微生物组靶向疗法已取得一些成功，特别是乳果糖和利福昔明，益生菌和 FMT 也显示出前景。然而，微生物组疗法在 HE 中的有效应用仍然存在一些挑战，包括微生物组对可持续变化的恢复力以及微生物群改变带来的不可预测的临床结果。该领域未来的工作应侧重于严格的试验设计、微生物组疗法选择和个性化的 HE 方法。