亚临床性肝性脑病的治疗对其转归的影响

Effects of Treatment on Prognosis in Cirrhotic Patients with Subclinical Hepatic Encephalopathy.

评价亚临床性肝性脑病治疗与否对其转归的影响。材料和方法:31例亚临床性肝性脑病病人随机化分为两组,治疗组16例,对照组15例。双盲法分别给予40％乳梨醇溶液0.55～1.75m1/kg-d,平均1.05ml/kg·d.一日三次,以获得每天1～2次软便,及安慰剂5％葡萄糖10ml,一日三次,均连续眼用两周。服药前后分别行数字连接试验(NCT)、数字符号试验(DS)、体表感觉诱发电位(SSEP)及血氨检查,并随访有无临床性肝性脑病发生。结果:治疗组血氨明显降低,NCT、DS改善.SSEP检查中的N_2、P_2、N_3、P_3潜伏期和N_1-P_2、N_1-N_3峰间潜伏期缩短,且未有发生临床肝性脑病者。对照组有2例发生临床性肝性脑病,未发生脑病者各项检测指标无改善。结论:亚临床性肝性脑病宜早诊早治。

Aims: To evaluate the effects of treatment or not on prognosis in cirrhotic patients with subclinical hepatic encephalopathy. Methods: Thirty-one cases of cirrhotic patients with subclinical hepatic encephalopathy were randomly allocated into two groups. Sixteen cases received an average of 1.05ml/kg·d (range 0.55-1.75ml/kg·d) of 40% lactitol solution orally three times a day to achieve one to two semiformed stools/d for two weeks. Fifteen cases were given placebo (5% glucose) 10ml orally three times a day as control also for a period of two weeks. Assessment of response included two psychometric tests: number connection test (NCT) and digit symbol (DS), somatosensory evoked potentials (SSEP), blood ammonia and clinical evaluation of mental status. Results: None showed evidence of overt hepatic encephalopathy in the treatment group. While 2 of the 15 patients in the control group showed evidence of overt hepatic encephalopathy. one is stage 3. the other is stage 4. The blood ammonia, the latency of N2, P2, N3, P3 and inter-peak latency of N1-P2, N1-N3 of SSEP were significantly decreased and the NCT and DS were significantly improved in the treatment group (P<0. 01). The differences found in the control group were not significant statistically. Conclusions: Subclinical hepatic encephalopathy should be treated to prevent the development of overt forms of the syndrome as early as possible.