清开颗粒综合干预慢性肝病后肝硬化并发轻微型肝性脑病的临床研究

Clinical study of Qingkai granules in comprehensive intervention of liver cirrhosis complicated with mild hepatic encephalopathy after chronic liver disease

目的观察清开颗粒综合干预慢性肝病后肝硬化并发轻微型肝性脑病(MHE)的临床疗效。方法将80例慢性肝病后肝硬化并发MHE患者按照随机数字表法分为2组。治疗组40例在一般支持对症治疗基础上加用清开颗粒;对照组40例在一般支持对症治疗基础上加用乳果糖口服液。2组均治疗12周后统计临床疗效,并观察2组治疗前及治疗4、8、12周血浆氨、内毒素水平,治疗前后数字连接试验(NCT-A)、数字符号试验(DST)、斯特鲁普测验(Stroop)情况。结果 2组治疗前及治疗4、8周血浆氨、内毒素水平组间比较差异均无统计学意义(P>0.05),12周组间比较差异有统计学意义(P<0.05);2组治疗前及治疗4、8、12周血浆氨、内毒素组内各时间点两两比较差异均有统计学意义(P<0.05)。治疗后2组NCT-A均减少(P<0.05),且治疗组少于对照组(P<0.05)。治疗后2组DST均升高(P<0.05),且治疗组高于对照组(P<0.05)。治疗后2组Stroop总时间均减少(P<0.05),但2组治疗后组间比较差异无统计学意义(P>0.05)。结论清开颗粒干预慢性肝病后肝硬化并发MHE患者,在降低患者血浆氨、内毒素水平方面疗效优于乳果糖口服液,提高患者注意集中能力、精神运动反应速度、精神运动的准确性、认知灵活性等方面较乳果糖口服液明显。

Objective To observe the clinical efficacy of Qingkai granules on mild miniature hepatic encephalopathy(MHE) in patients with chronic liver cirrhosis. Methods 80 patients with chronic liver cirrhosis complicated with MHE were divided into two groups according to random number table method. 40 cases in treatment group were treated by Qingkai granules on the basis of general supportive symptomatic treatment. 40 cases in control group were treated by lactulose oral liquid on the basis of general supportive symptomatic treatment. The curative effect was evaluated after 12 weeks of treatment in both groups. The plasma ammonia and endotoxin levels were observed before treatment and at 4, 8, and 12 weeks after treatment, and the digital connection test(NCT-A), digital sign test(DST), and Stroop test were observed before and after treatment. Results There was no significant difference in plasma ammonia and endotoxin levels between the two groups before treatment and 4, 8 weeks after treatment(P>0.05), but there was significant difference between the two groups at 12 weeks(P<0.05). There were significant differences in plasma ammonia and endotoxin levels between the two groups before treatment and at 4, 8 and 12 weeks after treatment(P<0.05). After treatment, the NCT-A was decreased in both groups(P<0.05), and the treatment group was less than the control group(P<0.05). After treatment, the DST was increased in both groups(P<0.05), and the treatment group was higher than the control group(P<0.05). After treatment, the total time of Stroop was decreased in both groups(P<0.05), but there was no significant difference between the two groups after treatment(P>0.05). Conclusion Qingkai granules is more effective than lactulose oral liquid in reducing plasma ammonia and endotoxin levels in patients with chronic liver cirrhosis complicated with MHE. It is better than lactulose oral liquid in improving concentration ability, speed of psychomotor response, accuracy of psychomotor and cognitive flexibility of patients.