幽门螺杆菌感染对血氨浓度的影响

Observation of the relationship between the Helicobacter pylori infection and the blood ammonia concentration

目的 探讨消化系统疾病中幽门螺杆菌 (HP)感染对患者血氨浓度变化的影响。方法 分别用全自动生化仪及尿素酶依赖性试验对 75例消化性溃疡患者的血氨浓度及HP感染情况进行动态观察。结果 HP阳性组入院时的血氨浓度明显高于HP阴性组和HP阳性组根除治疗后的血氨浓度 (P <0 .0 1) ;HP阴性组 2次血氨测定结果差异无显著性 (P >0 .0 5 )。HP阳性组中HP根除治疗结束时有 4例患者血氨浓度由入院时的正常范围转为增高 ,两者差异有显著性 (P <0 .0 1)。 3例合并肝硬化患者 ,经护肝与降血氨等治疗 ,血氨未下降 ;后经胃镜检查证实分别合并胃溃疡 1例、十二指肠球部溃疡 2例 ,检查HP均呈阳性 ,经应用PPI三联根除治疗 ,疗程 1周 ,其血氨均下降至正常。结论 HP感染能导致血氨浓度增高 ,可能为肝性脑病的诱因之一。肝硬化伴有上消化道出血病 ,若同时有HP感染 ,在HP根除治疗前 ,如静脉持续应用PPI等强效制酸剂 ,可较长时间引起胃内 pH值 >6 ,从而使胃内氨向血中弥散 ,有诱发或加重肝性脑病的可能 。

Objective To observe the relationship between the Helicobacter pylori (HP) infection and the blood ammonia concentration. Methods The urease test for HP infectioin and the blood ammonia concentration were detected in 75 patients with peptic ulcer. Results The blood ammonia concentration of HP postive group without treatment was higher than HP negative group and treated HP postive group ( P <0.01). There was no significant difference between the no treatment and treatment in HP negative group( P >0.05). The blood ammonia concentration of 4 cases of treated HP positive group was higher than before treatment. There was significant difference( P <0.01). The blood ammonia concentration of 3 cases with liver cirrhosis was still above normal after treatment. However after anti HP treatment, the blood ammonia concentration became normal. Conclusions The HP infection can lead to hyperammonemia. Applying Antacid treatment to the patient with cirrhosis, the bleeding of upper digestive tube and the HP infection can aggravate hepatic encephalopathy.