根除HP对肝硬化患者血氨的影响及与肝功能分级的关系

Effect of Helicobacter Pylori Eradication on Blood Ammonia in Patients with Liver Cirrhosis and its Relation to Liver Function Classification

目的探讨根除幽门螺杆菌(HP)对肝硬化患者血氨浓度的影响及与肝功能分级的关系。方法选择我院2006年1月～2008年7月经病史、临床表现、实验室检查、B超、CT及胃镜检查等确诊的肝硬化住院患者96例,其中A级33例、B级32例、C级31例。根据HP检查结果分为两组,HP阳性组46例;HP阴性组50例。选择同期HP检测阳性的普通患者42例作为对照组。HP阳性组和对照组患者在常规内科治疗基础上予以HP根治方案(奥美拉唑20mg或果胶秘240mg+阿莫西林1.0g或甲硝唑0.4g+克拉霉素0.5g,每天2次×7d)。HP阳性组和HP阴性组均给予低蛋白饮食[0.8～1.0g(/kg.d)],口服乳果糖10～20mL,3次/d,同时给予一般性保肝治疗,不用任何降血氨药物。结果①三组治疗前后血氨浓度的比较:治疗前HP阳性组血氨浓度比HP阴性组明显增高,经检验两者差异有统计学意义(P<0.05),HP阴性组与对照组比较差异无统计学意义(P>0.05)。治疗后HP阳性组仍阳性者血氨浓度显著高于转阴者,其差异有统计学意义(P<0.05)。HP阳性组转阴者及HP阴性组与对照组比较,差异无统计学意义(P>0.05)。②血氨浓度与肝功能分级的关系:HP阳性组患者不同肝功能分级血氨浓度之间差异有统计学意义(P<0.05)。HP阴性组患者不同肝功能分级的血氨浓度之间差异无统计学意义(P>0.05)。结论HP感染可使肝功能异常的肝硬化患者血氨浓度升高,根除治疗能有效降低血氨;对肝功能正常者血氨影响不大。

Objective To investigate the effect of Helicobacter pylori（HP） eradication on blood ammonia in patients with liver cirrhosis and its relation to liver function classification. Methods We selected 96 cases of liver cirrhosis in our hospital from Jan 2006 to July 2008 diagnosed by menstrual history, clinical manifestations,laboratory examination, B ultrasonic examination, CT and gastroscopy, etc, in which 33 cases were of A-grade,32 of B-grade and 31 of C-class. Two groups were divided into HP-positive group （46 cases）and HP-negative group（50 cases） according to HP test results. We chosed 42 cases of HP-positive ordinary patients detected in the same period as control group. HP-positive group and control group were given HP radical program based on the conventional treatment （omeprazole 20mg or pectin 240mg＋amoxicillin Peru 1.0g or Metronidazole 0.4g＋ Clarithromycin 0.5g, 2 times/d × 7d）. HP-positive and HP negative group were given low-protein diet [0.8 - 1.0g/（kg·d）],oral lactulose 10 - 20mL, 3 times/d,and at the same time given a general liver treatment,without any lowering ammonia drug. Results （1）The blood ammonia concentration of the four groups before and after treatment：pre-treatment blood ammonia concentration of HP-positive group was significantly increased compared with H P-negative group with a significant difference（P 〈 0.05）, and with no significant difference between HP-negative group and control group（ P 〉 0.05 ）. The post-treatment blood ammonia concentration of HP-positive group was significantly increased compared with HP-negative group with a significant difference（P〈 0.05）, and there was no significant difference in the post-treatment blood ammonia concentration in the HP-positive transfer to negative patients in both HP-positive group and HP- negative group compared with control group（P 〉 0.05 ）. （2）The relationship between ammonia concentration and liver function classification： there was significant difference between ammonia concentration and liver function classification in HP-positive group （P 〈 0.05 ）, but no significant difference between the two in HP-negative group（P〉 0.05 ）. Conclusion HP infection in abnormal liver function enables the blood ammonia concentration increased in patients with liver cirrhosis,the eradication treatment can effectively reduce ammonia, with little effect on ammonia in normal liver function.