亚临床肝性脑病与幽门螺杆菌相关性研究

Study on the correlation between subclinical hepatic encephalopathy and Helicobacter pylori infection

目的研究亚临床肝性脑病（SHE）的幽门螺杆菌（Hp）感染状况及其与血氨水平的关系。方法65例肝硬化患者经数字连接试验（NCT）、数字符号试验（DST）和脑电图（EEG）检查异常的SHE，检查血氨水平。其中经胃镜下取胃窦和胃体黏膜行快速尿素酶试验并作病理学检查检测Hp，两项均阳性判断为Hp感染的SHE30例和健康志愿者20例，予奥美拉唑、阿莫西林和克拉霉素的标准三联方案根除治疗1周，停药6—8周后行^14C-尿素呼气试验判断Hp根除情况。所有研究对象于停药6～8周后或第1次检查后7—9周复查血氨水平、NCT、DST和EEG。结果SHE患者Hp感染率（46．2％，30／65）高于健康志愿者（33．3％，20／60），但差异无统计学意义（P〉0．05）。SHE患者和健康志愿者中Hp感染患者根除治疗前后的血氨水平差异均无统计学意义（P〉0．05），SHE患者中Hp感染患者进行Hp根除治疗后NCT、DST和EEG检查结果未见改善。结论SHE的发生和血氨水平及Hp感染无关。

Objective To investigate the status of Helicobacter pylori（Hp）infection with subclinical hepatic encephalopathy （SHE） and the level of blood ammonia. Methods Sixty-five SHE patients and healthy volunteer were selected. In all subjects Hp was assessed by rapid urease test （RUT） and histological examination. It would be regarded as Hp infection if both the RUT and histological examination were positive. The level of blood ammonia was detected and number connection test （NCT）, digit symbol test （DST）and electroencephalogram （EEG）was performed. The patients could be diagnosed with SHE whichever of the three tests was abnormal. The patients with Hp infection were randomized received one-week standard treatment. Bacterial eradication was assessed with ^14C-urea breath test after the treatment of 6-8 weeks, meanwhile above mentioned examinalions were reassessed. Results The ratio of Hp infection in SHE patients （46.2%, 30/65 ）was higher than that in healthy controls （ 33.3% ,20/60）, but there was no significant difference（P〉 0.05）.The blood ammonia level before and after eradication had no significant difference（P〉 0.05）. No improvement was observed in above mentioned examinations after treatment. Conclusion There is no relationship between the level of blood ammonia and Hp infection in SHE.