幽门螺杆菌在轻微肝性脑病发病机制中的作用及HP根治治疗后临床影响

Role of Helicobacter pylori in pathogenesis of minimal hepatic encephalopathy and clinical impact after the treatment of HP

目的研究幽门螺杆菌(HP)在轻微肝性脑病(MHE)发病机制中的作用,并探讨实施HP三联根治疗法对减轻轻微肝性脑病临床症状的效果评价。方法对210例怀疑为肝硬化患者进行相关检查,从中筛选出肝硬化患者65例,采取神经心理、智能测试的方法对患者进行测试以确定MHE,共35例为研究组,而肝硬化非MHE30例为对照组;对所有患者均测量其空腹血氨水平,采取快速尿素酶试验检测HP感染,并针对HP感染患者给予抗HP三联疗法,疗程为1周;在治疗后,对患者再次进行神经心理、智能测试,空腹血氨检测及快速尿素酶试验。结果研究组患者中检出HP感染25例感染率为71.4%,对照组HP感染检出10例感染率为33.3%;研究组患者的血氨水平明显高于对照组,两者之间差异有统计学意义(P<0.05);待HP三联疗法后,研究组患者中HP感染阳性者的神经心理、智能测试结果恢复正常及血氨水平相较于同组HP感染阴性者有明显下降,且差异有统计学意义(P<0.05)。结论 HP感染与轻微肝性脑病有着极大的关联,同时HP三联根治疗法能明显改善MHE的临床症状并降低血氨水平。

OBJECTIVE To explore the role of Helicobacter pylori （HP） in the pathogenesis of minimal hepatic encephalopathy and discuss the effect of triple radical therapy on mitigation of clinical symptoms of minimal hepatic encephalopathy. METHODS The related examinations were carried out for the patients suspected for cirrhosis, 65 cases of patients with cirrhosis were screened out, the neuropsychological smart testings were taken for 210 patients so as to determine the MHE, a total of 35 cases of patients with cirrhosis were set as the study group, and 30 cases of non MHE patients were set as the control group. All the patients were measured the fasting blood ammonia levels, and rapid urease test was performed for the detection of HP infection. The patients with HP infections were given the anti HP triple therapy treatment for one week. After the treatment, the neuropsycholog- ical smart test was performed again, and the fasting blood ammonia detection and rapid urease test were also carried out. RESULTS There were 25 （71. 4%） cases with HP infections tested in the study group and 10 （33.3%） cases in the control group; the level of ammonia of the study group was significantly higher than that of the control group, the difference between the two groups was statistically significant （P〈0.05） ; after the triple therapy, the neuropsychology and the intelligent test results of the patients with HP infections in the study group returned to normal, and the blood ammonia level was significantly decreased as compared with the patients without HP infections in the same group, and the difference was statistically significant （P〈0.05）. CONCLUSION The HP infection is closely related to the pathogenesis of mild hepatic encephalopathy, while the triple radical therapy can significantly improve the clinical symptoms of MHE and reduce the level of blood ammonia.