不同方案幽门螺杆菌感染的根除对肝硬化患者血氨水平的影响

Study on Blood Ammonia Levels in Cirrhotic Patients With Different Programs for the Eradication of Helicobacter Pylori Infection

目的探讨不同方案幽门螺杆菌(Helicobacter pylori,Hp)感染的根除对Hp阳性的肝硬化患者血氨水平的影响。方法选择72例Hp阳性的肝硬化患者,随机分为2组,A组给予埃索美拉唑(20 mg,2次/d)加阿莫西林(1 000 mg,2次/d)加左氧氟沙星(500 mg,1次/d),疗程10天。B组给予埃索美拉唑(20 mg,2次/d)加阿莫西林(1000 mg,2次/d)加甲硝唑(400 mg,2次/d),疗程10天。疗程结束4周后复查Hp,观察Hp根除率,并比较治疗前及停止根除Hp治疗后4周空腹血氨水平。结果 (1)A组和B组的Hp根除率分别为91.7%和75.0%,A组HP根除率明显高于B组(P<0.05);(2)Hp根除治疗前,A组肝硬化患者的血氨水平为(82.8±8.1)μmol/L,B组肝硬化患者的血氨水平为(83.9±9.3)μmol/L,差异无统计学意义(P>0.05)。Hp根除治疗后,A组肝硬化患者的血氨水平为(34.3±6.3)μmol/L,B组肝硬化患者的血氨水平为(48.7±7.4)μmol/L,A组肝硬化患者的血氨水平显著低于B组,差异有统计学意义(P<0.05)。结论根除Hp治疗可以降低Hp阳性的肝硬化患者血氨水平,Hp根除率越高,血氨水平降低越明显,因而提高Hp根除率可能有助于预防和治疗Hp阳性的肝硬化肝性脑病的发生。

Objective To investigate the effect of Helicobacter pylori（Hp） infection eradication with different programs on blood ammonia levels in Hp positive cirrhotic patients.MethodsChoose 72 cases of the Hp positive patients with cirrhosis, randomly divided into 2 groups, group A was given esomeprazole （20 mg,2 times/d） and amoxicilin （1 000 mg,2 times/d） and levofloxacin （500 mg,1/d）, treatment for 10 days. Group B was given esomeprazole（20 mg,2 times/d） and amoxicilin（1000 mg,2 times/d） and metronidazole （400 mg,2 times/d）,treatment for 10 days.The end of the course of 4 weeks to review Hp,observe the Hp eradicate rate,and compare the treatment before and 4 weeks after stop Hp eradication therapy on an empty stomach blood ammonia level.Results （1）The eradication rate in group A cirrhotic patients and group B cirrhotic patients were 91.7% and 75.0% respectively. The eradication rate of group A was higher significantly than group B （P〈0.05）.（2）Before therapy of eradicating Hp, Blood ammonia levels in group A cirrhotic patients were （82.8±8.1）μmol/L and（83.9±9.3）μmol/L in group B, the difference had no statistical significance（P〉0.05）. After therapy of eradicating Hp, Blood ammonia levels in group A cirrhotic patients were （34.3±6.3）μmol/L and（48.7±7.4）μmol/L in group B, Blood ammonia levels in group A was lower significantly than group B （P〈0.05）.Conclusion HP eradication can reduce blood ammonia levels in Hp positive cirrhotic patients. The higher the eradication rate is, the lower the Blood ammonia levels wil be. Thus increasing the Hp eradication rate may be helpful in the prevention and treatment of Hepatic encephalopathy in Hp positive cirrhotic patients.