门冬氨酸和鸟氨酸联合治疗肝性脑病的疗效观察

Clinical efficacy of aspartate-ornithine on hepatic encephalopathy in patients with liver cirrhosis

目的观察联合使用门冬氨酸和鸟氨酸治疗各种肝硬化引起肝性脑病患者的临床疗效,探讨其对生化指标的影响。方法收集2004-08～2007-08乙肝、丙肝和酒精性肝硬化住院患者84例,住院期间均出现不同程度的肝性脑病,分为门冬氨酸和鸟氨酸治疗组与乙酰谷酰胺治疗组(各42例),治疗5～7d观察2组患者的临床表现,记录临床症状、体征的变化,检测治疗前后患者血氨和肝功能,判断临床疗效变化。结果2组患者均经过5～7d治疗后,门冬氨酸和鸟氨酸治疗组患者显效22例(52.4%),有效16例(38.1%),无效4例(9.5%),无死亡病例,总有效率为90.5%;乙酰谷酰胺治疗组患者显效16例(38.1%),有效14例(33.3%),无效8例(19.1%),死亡4例(9.5%),总有效率为71.4%。2组总有效率比较,差异有统计学意义(P<0.05)。另外,发现门冬氨酸和鸟氨酸治疗组患者的血氨水平比乙酰谷酰胺治疗组显著下降(P<0.05),而2组之间的血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酰转肽酶、胆红素和凝血酶原时间均无明显变化(P>0.05)。结论降低血氨是治疗肝性脑病的重要步骤,门冬氨酸联合鸟氨酸是控制肝性脑病发生的有效药物。

Objective To observe hepatic encephalopathy （HE） in patients with liver cirrhosis treated with combined aspartate and ornithine and evaluate the clinical efficacy and the effects on serum ammonia and liver function tests. Methods Eight-four patients with liver cirrhosis and acute hepatic encephalopathy were recruited from August 2004 to August 2007. They were randomly classified into treatment group and control group. Patients in treatment group （ n= 42） were treated with aspartate-ornithine, while control group （n= 42） was treated with acelglutamine. The efficacy was evaluated 5-7 days after treatment. The serum ammonia and other biological parameters were also determined subsequently. Results In aspartate-ornithine treating group, 22 patients showed marked improvement of clinical syndromes, 16 cases were improved, 4 cases were without any response, and no death was reported, the total efficacy rate was 90.5%. However, in control group, 16 patients demonstrated to be marked improvement, 14 patients were improved, 8 cases had no response, and 4 cases died, the total efficacy rate was 71.4%. There was a significant difference in total efficacy rate between the two groups （P〈0.05）. The serum ammonia in aspartate-ornithine treating group was also significantly decreased than that in control group （ P〈0.05）. Conclusion Down-regulating serum ammonia is an important step in controlling HE. Aspartate-ornithine is effective on treating HE in patients with liver cirrhosis.