微生态制剂联合门冬氨酸鸟氨酸治疗亚临床肝性脑病的效果分析

Efficacy of microecological agents combined with ornithine aspartate in treatment of patients with subclinical hepatic encephalopathy and its influence on liver function and cognitive function

目的观察微生态制剂与门冬氨酸鸟氨酸联合用于治疗亚临床肝性脑病(SHE)的疗效及对肝功能、认知功能的影响。方法于2020年1月—2023年12月期间筛选86例安徽理工大学第一附属医院收治的SHE患者并随机分组:对照组(43例)接受门冬氨酸鸟氨酸治疗,观察组(43例)加用微生态制剂治疗。治疗前及治疗8周后,检测血氨、C反应蛋白(CRP)、降钙素原(PCT)、肝生化指标[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(γ-GT)、总胆红素(TBil)],并评价认知功能量表数字连接试验(NCT)-A、NCT-B与数字符号试验(DST)结果。结果相比于对照组治疗后水平,观察组的血氨[(66.69±18.19)vs.(87.88±21.35)μmol/L]、CRP[(6.57±1.43)vs.(9.56±1.71)mg/L]、PCT[(0.21±0.08)vs.(0.29±0.09)ng/L]、AST[(49.14±9.75)vs.(55.21±11.06)U/L]、ALT[(35.81±5.79)vs.(48.35±7.21)U/L]、γ-GT[(60.89±9.71)vs.(73.25±11.61)U/L]、TBil[(45.61±7.32)vs.(50.37±8.42)U/L]水平降低更显著(P<0.05)。与对照组比较,观察组NCT-A(56.68±11.06 vs.60.01±12.14)、NCT-B(67.76±12.83 vs.71.85±14.69)、DST(105.42±21.68 vs.126.48±23.41)评估结果的降幅更显著(P<0.05)。观察组4.65%转化为HE,低于对照组的HE转化率(16.28%,P<0.05)。结论微生态制剂联合门冬氨酸鸟氨酸治疗SHE能够降低血氨及炎症因子水平,保护肝功能及认知功能,降低HE转化风险。

Objective To observe the therapeutic effect of microecological agents combined with ornithine aspartate in treatment of patients with subclinical hepatic encephalopathy(SHE)and its influence on liver function and cognitive function.Methods A total of 86 SHE patients were collected from January 2020 to December 2023,and were randomly divided into two groups.The control group(43 cases)received ornithine aspartate treatment,and the observation group(43 cases)received ornithine aspartate combined with microecological agents.Before treatment and 8 weeks after treatment,the blood ammonia,C-reactive protein(CRP),procalcitonin(PCT),and liver function indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),γ-Glutamyltransferase(γ-GT)and total bilirubin(TBil)]were measured.The cognitive function was evaluated by the Number Connection Test(NCT-A),NCT-B,and Digital Sign Test(DST).Results Compared to control group after treatment,the blood ammonia(66.69±18.19μmol/L vs.87.88±21.35μmol/L),CRP(6.57±1.43 mg/L vs.9.56±1.71 mg/L),PCT(0.21±0.08 ng/L vs.0.29±0.09 ng/L),AST(49.14±9.75 U/L vs.55.21±11.06 U/L),ALT(35.81±5.79 U/L vs.48.35±7.21 U/L),γ-GT(60.89±9.71 U/L vs.73.25±11.61 U/L)and TBil(45.61±7.32 U/L vs.50.37±8.42 U/L)both decreased in the observation group,with statistical significance(all P<0.05).Compared to control group after treatment,the levels of NCT-A(56.68±11.06 vs.60.01±12.14),NCT-B(67.76±12.83 vs.71.85±14.69),and DST(105.42±21.68 vs.126.48±23.41)in the observation group were significantly higher(all P<0.05).There was 4.65%of patients converted to HE in the observation group,significantly lower than the HE conversion rate of 16.28%in control group(P<0.05).Conclusion The combination treatment of microecological agents and ornithine aspartate can reduce blood ammonia and inflammatory factor levels,protect liver and cognitive function in SHE patients,and may reduce the risk of HE conversion.