精氨酸联合纳洛酮治疗肝硬化合并肝性脑病的疗效

Efficacy of arginine combined with naloxone in the treatment of cirrhotic with hepatic encephalopathy

目的探讨精氨酸联合纳洛酮治疗肝硬化合并肝性脑病的应用效果。方法回顾分析86例肝硬化合并肝性脑病患者的临床资料,根据治疗方法不同分为对照组(41例)和观察组(45例)。对照组则单纯采用精氨酸治疗,观察组在一般治疗的基础上采取精氨酸联合纳洛酮治疗。比较两组患者治疗前后的血氨(NH_(3))、血浆β-内啡肽(β-EP)水平以及血清总胆红素(TBIL)、谷丙转氨酶(ALT)、门冬氨酸氨基转移酶(AST)水平;清醒时间;不良反应发生率。结果治疗后,两组患者NH_(3)、β-EP水平均低于治疗前,且观察组患者β-EP(409.65±176.81)ng/L低于对照组的(791.36±278.23)ng/L,差异均具有统计学意义(P<0.05),但两组患者治疗后的NH_(3)水平比较,差异无统计学意义(P>0.05)。治疗后,观察组患者血清TBIL为(38.11±9.93)μmol/L,ALT为(69.82±8.01)U/L,AST为(72.86±9.65)U/L;对照组患者TBIL为(45.39±12.67)μmol/L,ALT为(89.58±4.26)U/L,AST为(92.55±13.37)U/L。两组患者血清TBIL、ALT、AST水平均低于治疗前,且观察组低于对照组,差异均具有统计学意义(P<0.05)。观察组患者清醒时间(11.42±4.23)h短于对照组的(27.51±5.76)h,差异具有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在肝硬化合并肝性脑病的治疗中使用精氨酸联合纳洛酮,其疗效确切,能显著改善患者症状,缩短清醒时间,进一步改善肝脏功能,用药较安全,具有较高的应用效果。

Objective To discuss the effect of arginine combined with naloxone in the treatment of cirrhotic with hepatic encephalopathy.Methods A total of 86 patients with cirrhosis and hepatic encephalopathy were divided into control group(41 cases)and observation group(45 cases)according to different treatment methods.The control group was treated with arginine alone,and the observation group was treated with arginine and naloxone on the basis of general treatment.Both groups were compared in terms of ammonia(NH_(3)),plasma β-endorphin(β-EP),serum total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST),awake time,and incidence of adverse reactions.Results After treatment,the NH_(3) and β-EP levels of the two groups were lower than those of this group before treatment,and theβ-EP(409.65±176.81)ng/L of the observation group was lower than(791.36±278.23)ng/L of the control group,and the difference was statistically significant(P<0.05).But there was no statistically significant difference in NH_(3) between the two groups after treatment(P>0.05).After treatment,the serum TBIL,ALT and AST were(38.11±9.93)μmol/L,(69.82±8.01)U/L,and(72.86±9.65)U/L in the observation group,and(45.39±12.67)μmol/L,(89.58±4.26)U/L,and(92.55±13.37)U/L in the control group.The serum TBIL,ALT,and AST of the two groups were lower than those of this group before treatment,and the observation group was lower than the control group,and the difference was statistically significant(P<0.05).The awake time(11.42±4.23)h of the observation group was shorter than(27.51±5.76)h of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Arginine in combination with naloxone has definite efficacy in the treatment of cirrhotic with hepatic encephalopathy,and can significantly improve the symptoms of patients,shorten the awake time,further improve liver function.The medication is safer and has a high application effect.