幽门螺杆菌感染及其根除治疗对轻微肝性脑病患者的临床价值

Clinical value of Helicobacter pylori infection and its eradication treatment in patients with mild hepatic encephalopathy

目的探讨幽门螺杆菌(H.pylori)感染与轻微肝性脑病(mild hepatic encephalopathy,MHE)的关系,分析根除H.pylori对MHE的临床价值。方法选取我院2018年11月至2020年8月诊断为MHE的患者56例,同期健康体检者40名,将13 C呼气检测H.pylori阳性的42例患者随机分为观察组和对照组,各21例。检测两组患者ALT、AST、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、血氨水平及NCT、DST评分,同时对观察组患者行H.pylori根除治疗,比较两组治疗前后上述指标水平的变化情况。结果与健康体检者相比,MHE患者更易合并H.pylori感染,差异有统计学意义(χ^(2)=4.61,P<0.05);观察组与对照组H.pylori根除治疗前ALT、AST、TBIL、DBIL、IBIL、血氨水平变化及NCT、DST评分方面差异均无统计学意义(P>0.05),根除治疗后较治疗前DST评分值升高,余指标均下降,且对照组明显优于观察组,差异有统计学意义(P<0.05)。结论H.pylori感染与MHE密切相关,H.pylori根除治疗后能够改善患者肝功能,降低血氨水平,缓解患者的临床症状,对治疗MHE具有一定的指导意义。

Objective To investigate the relationship between Helicobacter pylori(H.pylori)infection and mild hepatic encephalopathy(MHE),and to analyze the clinical value of eradication of H.pylori on MHE.Methods A total of 56 patients diagnosed with MHE in the Zhengzhou People’s Hospital Affiliated to Xinxiang Medical College from Nov.2018 to Aug.2020 and 40 healthy physical examination people in the same period were selected.42 patients with H.pylori positive 13 C breath test was randomly divided into observation group and control group with 21 cases each.ALT,AST,total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),serum ammonia levels,NCT scores and DST scores were measured in the two groups.Meanwhile,H.pylori eradication was performed in the observation group to compare the changes of the above indexes before and after treatment in the two groups.Results Compared with healthy physical examination people,patients with MHE were more likely to be associated with H.pylori infection,and the difference was statistically significant(χ^(2)=4.61,P<0.05).There were no significant differences in ALT,AST,TBIL,DBIL,IBIL,blood ammonia levels,NCT and DST score between observation group and control group before eradication treatment(P>0.05).After eradication treatment,DST scores were higher than those before treatment,while other indexes were decreased,and the control group was significantly better than the observation group,with statistically significant differences(P<0.05).Conclusion H.pylori infection is closely related to MHE.The eradication of H.pylori can improve the liver function of patients,reduce the level of blood ammonia,and relieve the clinical symptoms of patients,which has certain guiding significance for the treatment of MHE.