幽门螺杆菌的根治对肝硬化患者血氨的影响

Effects of the eradication of H pylori in patients with liver cirrhosis and hyperammonaemia

目的评价肝硬化患者Hp感染状况对血氨浓度的影响。方法对46例肝硬化伴高血氨患者的血液以及胃液中氨浓度进行分析,所有患者给予低蛋白饮食、卡那霉素、乳果糖以及丰富的支链氨基酸溶液治疗,其中24例患者仍有高血氨,根据Hp感染分布的状况,把24例患者分成三组:Hp在胃中弥漫性分布的患者为Ⅰ组,Hp在胃中局部分布的患者为Ⅱ组,Hp阴性的患者为Ⅲ组。24例患者均给予口服10 mg雷贝拉唑,1000 mg阿莫西林以及400 mg克拉霉素或500 mg甲硝唑2周进行Hp的根治。结果第Ⅰ组Hp根治后血液以及胃液中血氨浓度明显下降,Hp根治12周后血氨浓度明显降低(P<0.05),第Ⅱ组、Ⅲ组进行Hp根治后血氨浓度未见明显降低。结论胃中Hp弥漫性感染是导致肝硬化患者血氨升高的原因之一,针对Hp弥漫性分布的肝硬化患者,必须进行有效的Hp根治。

Objective This study aimed to evaluate whether ammonia levels were influenced by H pylori status in a series of 46 cirrhotic patients. Methods Ammonia concentrations in blood and gastric juice were analysed in 46 patients with liver cirrhosis and hyperammonaemia. All patients were first treated with a low protein diet, kanamycin, lactulose, and branched chain enriched amino acid solution. Hyperammonaemia remained in 24 patients. These 24 patients were divided into three groups according to the status of H pylori infection, those with a diffuse distribution of H pylori in the stomach （group Ⅰ）, those with a regional distribution （group Ⅱ）, and those without H pylori （group Ⅲ）. These patients were given 10 mg rabeprazole, 1000 mg amoxicillin, and 400 mg clarithromyc in or 500 mg metronidazole for two weeks to eradicate H pylori. Results In group Ⅰ ammonia concentrations in blood and gastric juice were significantly reduced after H pylori eradication（ P 〈 0.05 ）. The blood ammonia concentration at 12 weeks after the eradication was still significantly lower than that before eradication. In groups Ⅱ and Ⅲ the ammonia concentrations in blood and gastric juice were not significantly reduced after eradication therapy. Conclusion The diffuse distribution of H - pylori in the stomach contributes partly to hyperammonaemia in patients with liver cirrhosis, and the e- radication of H pylori is effective in patients with hyperammonaemia with diffuse H pylori infection in the stomach.