乙型肝炎肝硬化患者幽门螺杆菌感染与血氨水平的关系

A clinical study of the relationship between blood ammonia concentration in patients with liver cirrhosis after chronic hepatitis B and Helicobacter pylori infection

目的:探讨乙型肝炎肝硬化患者幽门螺杆菌(Helicobacterpylori,Hp)感染与血氨的关系,为临床防治肝性脑病是否需要常规根除Hp提供理论依据。方法:收集86例乙肝肝硬化住院患者,分Hp(+)组和Hp(-)组,并选取同期住院的Hp阳性的胃溃疡或胃炎患者60例作为对照组。Hp(+)组以埃索美拉唑、克拉霉素及阿莫西林行Hp根治性治疗,分别检测各组的空腹血氨及Hp(+)组治疗前后血氨浓度变化。根据肝功能Child分级及食管静脉曲张程度进行分组,比较各组血氨水平。结果:Hp(+)组血氨浓度明显高于Hp(-)组,差异有显著性(P<0.01);Hp(+)组根除Hp后血氨浓度较治疗前明显下降,差异有显著性(P<0.005)。Hp(+)组中Child-PughB、C级血氨浓度明显高于A级,差异有显著性(P<0.01),Ⅰ°、Ⅱ°食管静脉曲张血氨水平Hp(+)组明显高于Hp(-)组,差异有显著性(P<0.05)。结论:Hp感染可使乙肝肝硬化患者血氨水平升高,根除Hp有助于预防和治疗乙肝肝硬化高氨血症。

Objective To study the influence of Helicobacter pylori （Hp） infection on blood ammonia concentration in chronic hepatitis B patients with liver cirrhosis. The purpose of this study is to provide a theoretical basis for developing prevention and treatment of hepatic encephalopathy through eradicating Hp. Methods Eightysix chronic hepatitis B patients with liver cirrhosis were enrolled and classified into Hp infection group and without Hp infection group. Sixty peptic ulcer or gastritis patients with Hp infection were chosen as a control group. The patients with Hp infection received eradication therapy with esomeprazole plus clarithromyein and amoxieillin. Blood ammonia levels of each group were measured, respectively. Blood ammonia levels of Hp infection was measured before and after eradication therapy. Eighty-six patients were divided into groups according to Child-Pugh classification and the degree of esophagus varicosis. The blood ammonia levels of each group were compared. Results The blood ammonia concentrations in the liver cirrhosis patients with Hp were significantly higher than that of those liver cirrhosis patients without Hp （P 〈 0.01 ）. The blood ammonia concentrations reduced significantly after treatment of lip eradication in the liver cirrhosis patients with Hp compared with before eradication （P 〈 0.005）. The blood ammonia concentrations of the lip positive patients with Child-Pugh degree B and C were significantly higher than those of the Hp postive patients with Child-Pugh degree A （P 〈 0.01 ）. The blood ammonia concentrations of I °, II° esophageal varieosis in lip positive groups were significantly higher than those of the lip negative groups （P 〈 0.05）. Conclusion Hp infection induces hyperammonaemia in liver cirrhosis patients and the lip eradication therapy is helpful in the treatment and prevention of hyperammonaemia in the chronic hepatitis patients with liver cirrhosis.