利福昔明联合乳果糖治疗肝性脑病患者疗效及其血清S100B蛋白和神经元特异性烯醇化酶变化

目的 探讨应用利福昔明联合乳果糖治疗肝性脑病(HE)患者的疗效及其血清S100B蛋白和神经元特异性烯醇化酶(NSE)水平的变化。方法 2015年6月~2019年6月我院收治的失代偿期乙型肝炎肝硬化并发HE患者74例,随机分为观察组37例和对照组37例。在内科治疗的基础上,给予对照组乳果糖口服,给予观察组乳果糖联合利福昔明治疗,两组均治疗1周。采用ELISA法检测血清C-反应蛋白(CRP)、肿瘤坏死因子-(TNF-)和白介素-6(IL-6),采用电化学发光法检测血清S100B蛋白、NSE和血浆β-内啡肽 (β-EP)水平,常规检测血氨。应用数字连接试验(NCT)和数字符号试验(DS)评价认知功能。结果 观察组生存率为83.8%,显著高于对照组的62.1%(P<0.05);治疗后,观察组31例生存患者血清CRP水平为(14.9±3.5)mg/L,显著低于23例对照组【(17.4±3.8)mg/L,P<0.05】,血清TNF-α水平为(12.3±3.8)ng/L,显著低于对照组【(15.3±4.4)ng/L,P<0.05】,血清IL-8水平为(35.8±7.5)pg/mL,显著低于对照组【(41.5±9.8)ng/L,P<0.05】,血清S100B蛋白水平为(27.4±13.1)ng/L,显著低于对照组【(38.7±14.0)ng/L,P<0.05】,血清NSE水平为(14.6±6.4)μg/L,显著低于对照组【(19.4±8.3)μg/L,P<0.05】,血浆β-EP水平为(46.7±5.3)pg/mL,显著低于对照组【(52.8±6.7)pg/mL,P<0.05】;血清丙氨酸氨基转移酶(ALT)水平为(67.3±16.1)U/L,显著低于对照组【(92.5±21.8)U/L,P<0.05】,而血清白蛋白(ALB)水平为(35.3±7.1)g/L,显著高于对照组【(32.7±6.8)g/L,P<0.05】,血氨水平为(61.7±11.4)μmol/L,显著低于对照组【(98.1±13.3)μmol/L,P<0.05】; NCT时间为(54.3±8.5)s,显著短于对照组【(69.7±10.8)s,P<0.05】,而DS评分为(58.5±7.2)分,显著高于对照组【(47.3±8.9)分,P<0.05】。结论 应用利福昔明联合乳果糖治疗肝硬化引起的HE患者可有效抑制炎症反应,改善肝功能,减轻神经系统功能损伤,降低血氨、血清S100B蛋白和NSE水平,提高认知功能,疗效较好。

Combination of rifaximin and lactulose improves clinical efficacy and mortality in hepatitis B cirrhotic patients with hepatic encephalopathy

Objective The aim of this study was to investigate combination of rifaximin and lactulose in dealing with hepatitis B cirrhotic patients with hepatic encephalopathy(HE)and observe its clinical efficacy and mortality.Methods 74 patients with HE were admitted to our hospital between June 2015 and June 2019,and were randomly divided into two groups,with 37 cases in each.37 patients were treated with lactulose and another 37 with lactulose and rifaximin combination for seven days.Serum S100B protein,neuron-specific enolase(NSE),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8)andβ-endorphin,β-EP were assayed,and number connection test(NCT)and digital symbol test(DS)were applied for evaluation of cognition.Results The survival rate in combination group was 83.8%,significantlyhigher than 62.1%in lactulose-treated group(P<0.05);after treatment,serum CRP level in the combination group was(14.9±3.5)mg/L,much lower than(17.4±3.8)mg/L,P<0.05],serum TNF-αlevel was(12.3±3.8)ng/L,significantly lower than(15.3±4.4)ng/L,P<0.05],serum IL-8 level was(35.8±7.5)pg/mL significantly lower than(41.5±9.8)ng/L,P<0.05],serum S100B protein level was(27.4±13.1)ng/L,significantly lower than(38.7±14.0)ng/L,P<0.05],serum NSE level was(14.6±6.4)μg/L,significantly lower than(19.4±8.3)μg/L,P<0.05],and plasmaβ-EP level was(46.7±5.3)pg/mL,significantly lower than(52.8±6.7)pg/mL,P<0.05]in lactulose-treated group;serum alanine aminotransferase(ALT)level was(67.3±16.1)U/L,significantly lower than(92.5±21.8)U/L,P<0.05],while serum albumin(ALB)level was(35.3±7.1)g/l,significantly higher than(32.7±6.8)g/L,P<0.05]in lactulose-treated group;the blood ammonia level was(61.71±1.4)μmol/L,significantly lower than(98.1±13.3)μmol/L,P<0.05]in lactulose-treated group;the time of NCT was(54.3±8.5)s,which was much shorter than(69.7±10.8)s,P<0.05],and the DS score was(58.5±7.2),which was significantly higher than(47.3±8.9),P<0.05]in lactulose-treated group.Conclusion The combination of rifaximin and lactulose in the treatment of cirrhotic patients with HE could effectively inhibit the inflammatory reaction,improve liver functions,reduce stress injury,and improve cognitive functions,which might correlated to the reduction of serum S100B protein and NSE levles,and is worthy of further clinical research.