纳洛酮治疗肝硬化亚临床型肝性脑病疗效观察

The therapeutic effects of naloxone on cirrhotic patients with subclinical hepatic encephalopathy

目的：评估纳洛酮治疗肝硬化工临床型肝性脑病（ＳＨＥ）的疗效。方法：４７例ＳＨＥ随机分为治疗组２４例（Ａ组），对照组２３例（Ｂ组）。双盲法分别给予治疗组纳洛酮０．４ ｍｇ（１ｍＬ）、对照组０．９％氯化钠１ｍＬ，均１日 １次肌肉注射，连用 １０日。用药前后分别行数字连接试验（ＮＣＴ）、数字符号试验（ＤＳ）检测及测定血氨，并随访有否发生临床型肝性脑病。结果：治疗组治疗后 ＮＣＴ、 ＤＳ均比治疗前明显改善，Ｐ＜０．０１，且无１例发展为临床型肝性脑病。不良反应轻微。对照组治疗前后ＮＣＴ、ＯＳ无变化，发生临床型肝性脑病３例。结论：纳洛酮是一种有效、安全的ＳＨＥ治疗药物，值得临床推广试用。

Objective: To evaluate the effects of naloxone (NX) on cirrhotic patients with subclinical hepatic encephalopathy (SHE). Methods: Forty-seven cirrhotic patients with SHE diagnosed using psychometric tests were enrolled in the study. A randomi- zed double-blind design was used to assign 24 patients in the experimental group and 23 patients in the control group. In the experi- mental group, the patients were given 0.4 mg of NX intramscularly once a day for 10 days while the controls were treated with normal saline. Number connection test (NCT) and digit symbol test (DS) were performed in all patients before and after the treatment. The clinical mental status was also observed. Results: In the experimental group, no evidence of hepatic encephalopathy (HE) was found and the NCT and DS improved significantly after NX treatment (P<0.01). In the control group, the NCT and DS did not change signifi- cantly after treatment and three patients developed HE. Conclusion: NX is a safe and effective agent in treating SHE.