门冬氨酸鸟氨酸联合乳果糖对老年肝性脑病疗效和NSE的影响

目的研究门冬氨酸鸟氨酸联合乳果糖对老年肝性脑病(HE)疗效和神经元特异性烯醇化酶(NSE)的影响。 方法选取270例老年HE患者,按不同治疗方式均分为门冬组(门冬氨酸鸟氨酸)和联合组(门冬氨酸鸟氨酸联合乳果糖)。比较两组疗效,及治疗前、后肝功能、血氨、炎症因子、NSE和认知功能评估。 结果联合组治疗总有效率高于门冬组(P＜0.05)。治疗后两组血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、血氨、白细胞介素-8、C-反应蛋白及NSE水平低于治疗前,且联合组低于门冬组(P＜0.05)。治疗后两组MMSE评分和HDS-R评分高于治疗前,且联合组高于门冬组(P＜0.05)。 结论采用门冬氨酸鸟氨酸联合乳果糖治疗老年HE患者可提高临床疗效,改善NSE水平,在临床上可推广使用。     

复合乳酸菌胶囊联合乳果糖治疗便秘型肠易激综合征的疗效观察

目的 观察复合乳酸菌胶囊联合乳果糖治疗便秘型肠易激综合征（IBS）的临床疗效.方法 150例便秘型IBS患者随机均分为A、B、C 3组,所有患者给予马来酸曲美布汀片作为基础治疗,A组患者口服复合乳酸菌胶囊,B组患者口服乳果糖口服溶液,C组联合服用上述两种药物.比较2个疗程后的疗效.结果 3组临床症状评分均有下降,C组患者下降幅度最大,与A、B两组比较有统计学差异（p〈0.05）.C组总有效率较高,但3组间总有效率未能体现统计学差异.结论 复合乳酸菌胶囊和乳果糖联合辅助治疗便秘型IBS,具有协同效应.     

妈咪爱联合乳果糖口服液治疗婴幼儿功能性便秘的临床观察

目的观察妈咪爱联合乳果糖口服溶液治疗婴幼儿功能性便秘（FC）的疗效。方法 80例功能性FC患儿按随机数字表法分为两组,对照组40例采用一般疗法（调节饮食;训练排便习惯;每天进行适量活动）,治疗组40例在此基础上加服妈咪爱及乳果糖口服溶液,疗程均为21 d。观察便秘改善情况,并采用多功能消化道测压仪检测治疗前后直肠肛门动力学的改变。结果治疗组总有效率为91.3%,明显高于对照组的53.1%（P〈0.01）;两组治疗后直肠最低敏感量和最大耐受量均较治疗前降低（P〈0.05）,但治疗组治疗后的降低幅度明显高于对照组（P〈0.01）。结论妈咪爱联合乳果糖口服液可有效恢复FC患儿肠道正常微生态,纠正直肠肛门动力学障碍,解除便秘。     

乳果糖联合培菲康对肝硬化自发性腹膜炎血清和腹水TNF-α、IL-6水平的影响

目的探讨乳果糖联合培菲康对肝硬化自发性细菌性腹膜炎血清及腹水TNF-α、IL-6水平的影响。方法选择自发性细菌性腹膜炎患者120例,随机分为对照组（n=60）和治疗组（n=60）,另外选择健康体检者30例为健康对照组。所有患者均于治疗前、治疗后7 d测定血清及腹水TNF-α、IL-6水平,并统计患者的病死率。结果治疗组和对照组患者血清及腹水TNF-α、IL-6水平显著高于健康对照组（P〈0.05）;治疗后相比,治疗组血清及腹水TNF-α、IL-6水平较对照组明显下降（P〈0.05）;治疗组的病死率明显低于对照组。结论乳果糖联合培菲康可以降低肝硬化自发性腹膜炎患者血清及腹水TNF-α、IL-6水平,改善患者预后。     

退黄降氨汤灌肠治疗肝性脑病76例

[目的]观察退黄降氨汤保留灌肠治疗肝性脑病的疗效。[方法]将152例肝性脑病患者随机分为治疗组76例,对照组76例,均采用综合治疗;治疗组加用退黄降氨汤治疗,对照组加用乳果糖治疗,2组疗程均为7d。两组患者治疗前后做血氨检查,观察患者清醒时间。[结果]治疗组降低血氨优于对照组(P<0.05),且缩短昏迷的时间。在疗效方面,治疗组有效率为82.9%(63/76);对照组有效率为67.1%(51/76),两组比较有显著性差异(P<0.01)。[结论]退黄降氨汤保留灌肠可有效地降低血氨,促进患者苏醒,缩短昏迷的时间。     

Sensitivity of a hyperosmolar or “low”-osmolar test solution for sugar absorption in recognizing small intestinal mucosal damage in coeliac disease

Reliability of differential sugar absorption tests is hampered by a lack of standardization of the content and osmolarity of the test solutions. We evaluated the effect of osmolarity of the test solution of the sugar absorption test on the 5 hour urine excretion of orally administered lactulose and mannitol. A group of 28 controls and 14 coeliacs, with villous atrophy grade 11 to IV, ingested a hyperosmolar sugar absorption test solution and a “low”-osmolar solution, respectively. After an overnight fast, each subject ingested hyperosmolar sugar absorption test solution (2 g mannitol, 5 g lactulose and 40 g sucrose/100 ml (around 1560 mmol/1]]. After two days, this procedure was repeated with low-osmolar solution (2 g mannitol and 5 g lactulose/100 ml (around 375 mmol/1). The influence of the sequence of the tests on the results had previously been excluded. All urine from the 5 h-period following ingestion of the test solution was collected. To calculate the low-osmolar solution ratio, samples were analysed for lactulose and mannitol concentrations by gas chromatography. The sensitivity of hyperosmolar SAT solution and low-osmolar solution for the detection of mucosal abnormalities in coeliacs was 64% and 43%, respectively. In conclusion, a hyperosmolar solution discriminates better between normal and damaged mucosa of the small bowel such as villous atrophy due to a relative increase in permeability for lactulose.     

Differential trafficking of saccharidic probes following aspirin in clinical tests of intestinal permeability in young healthy women

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Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose

Background and Aim: Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using lactulose in patients who never had HE earlier. Methods: Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive lactulose (Gp‐L) or no lactulose (Gp‐NL). All patients were assessed by psychometry (number connection test [NCT‐A and B], figure connection test if illiterate [FCT‐A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE. Results: Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp‐L (n = 60) and Gp‐NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the lactulose (Gp‐L) group and 14 (28%) of 50 in the Gp‐NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp‐NL and five (9%) of 55 patients in the Gp‐L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp‐L vs Gp‐NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp‐L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE. Conclusions: Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis.     

Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction

Background/Aims:

Minimal hepatic encephalopathy (MHE) is common in patients with extrahepatic portal vein obstruction (EHPVO). There is no study on the treatment of MHE using lactulose in patients with EHPVO.

Patients and Methods:

Consecutive EHPVO patients were assessed by psychometric (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), and critical flicker frequency (CFF) at inclusion. Patients diagnosed as MHE were treated with lactulose and psychometric tests, CFF, and were reassessed after 3 months.

Results:

Of the 70 patients screened, the prevalence of abnormal psychometric test was as follows: NCT-A (41%), NCT-B (53%), DST (38%), SDT (40%), and LTT (44%). Thirty patients (43%) had two or more than two abnormal (>2 SD) psychometry tests. Lactulose improved MHE in 16/30 (53%) of patients after 3 months of treatment. Arterial ammonia decreased after lactulose treatment compared to baseline (83.7±19.1 vs. 65.1±19.3 μmol/l, P=0.001). A total of 9 (75%) of 12 patients with large spontaneous shunt and 7 (39%) of 18 patients without spontaneous shunt improved with lactulose (P=0.07). CFF in patients with MHE (n=30) was significantly lower than those without MHE (n=40) (38.1±2.4 vs. 41.5±3.1 Hz, P=0.01). CFF was less than 38 Hz in 21 (70%) of 30 patients before treatment and in 10 (33%) patients after lactulose therapy in MHE patients. All patients could tolerate lactulose without any significant side effects. Four patients (13%) developed transient diarrhea in whom dose needed reduction, 3 (10%) did not like its taste but have continued, and 2 (6%) developed abdominal bloating sensation.

Conclusions:

Lactulose is effective in the treatment of MHE in patients with EHPVO.     

Efficacy of lactulose plus <Superscript>13</Superscript>C-acetate breath test in the diagnosis of gastrointestinal motility disorders

Background: Background: We designed a new method of measuring gastric emptying and orocecal transit time (OCTT) at the same time to assess the influence of gastric emptying upon OCTT. Methods: Twenty-five dyspeptic patients (6 men, 19 women) with a mean age of 64.8 years (range, 25–80 years) were studied. The patients received a liquid test meal, containing 100 mg of ¹³C-acetate and 12 g of lactulose, while they were in the sitting position after an overnight fast. Breath samples were collected at 10-min intervals of 120 min and both ¹³CO₂ and hydrogen (H₂) levels were measured. Subsequently, H₂ concentrations were measured at 30-min intervals, for a total of 240 min. Results: The results of gastric emptying were expressed as the time of peak ¹³CO₂ excretion. OCTT was defined as the period between the ingestion of lactulose and a H₂ peak rise of 5 ppm above the baseline value. The onset of H₂ enrichment in the breath began at 90–110 min, whereas ¹³CO₂ levels increased from the beginning, with peak enrichment values being reached after 60–80 min. OCTT was related to ¹³CO₂ peak time. In 5 of the 25 patients, H₂ breath enrichment in the 10-min sample was more than 5 ppm over the baseline value. All these 5 patients had double or triple peaks in serial breath H₂ concentrations. Conclusions: The combination of the lactulose hydrogen breath test (LHBT) with the ¹³C-acetate breath test, which requires only breath samples, provides us with much information on the gastrointestinal tract; gastric emptying, OCTT, bacterial overgrowth in the small intestine, colonic fermentation, and oropharyngeal flora. The ¹³C-acetate breath test can be useful as an adjuvant test when LHBT is performed for measuring OCTT. Received: March 5, 2001 / Accepted: October 5, 2001