乳果糖治疗亚临床肝性脑病的临床研究

目的 前瞻性对比乳果糖长、短程治疗对亚临床肝性脑病(SHE)的效果及其对SHE病程的影响。方法 经智力测验(数字连接试验和数字符号试验之一异常)诊断的SHE 64例随机分入对照组(21例)、短程组(21例)和长程组(22例),后2组分别服乳果糖达8周和24周。治疗前以及治疗后每间隔8周行血氨、智力测验和体感诱发电位(SEP)等检查,共随访24周。结果 每组各有20例完成追踪。与对照组和治疗前相比,长程组血氨和智力测验显著改善(P＜0．05—0．01)且SEP的N50波潜伏期稳定不变,短程组治疗到第8周也有改善(P＜0．05),但停药后又逐渐恶化。对照组的血氨、智力测验和N50波潜伏期逐渐恶化,在16周时后2项与治疗前差异有显著性(P＜0．05—0．01);而长程组血氨持续降低,其肝性脑病(HE)患病率(5％)显著低于短程组(30％)和对照组(40％)(P＜0．05)。结论 乳果糖维持治疗能够降低血氨、改善智力测验结果并可能防止SEP的恶化,最终降低HE的患病率。

Long-term efficacy of lactulose in patients with subclinical hepatic encephalopathy

Objective To observe the long term clinical efficacy of lactulose in patients with subclinical hepatic encephalopathy(SHE) and the natural history of this disease Methods Patients with SHE diagnosed with psychometric tests (number connection test and digit symbol test) were randomly allocated to control group (Cg), short term (Stg) and long term treatment group(Ltg), respectively Lactulose (15-90 ml/day) was orally given to 21 patients in Stg for 8 weeks, and 22 in Ltg for 24 weeks The drug was not given to 21 patients in Cg Psychometric test, somatosensory evoked potentials (SEP) and venous blood ammonia concentration (BA) were investigated before and after treatment at 8 week intervals for 6 months of follow up Results In Ltg, psychometric tests were significantly improved, BA was lowered and N 50 peak latency in SEP was not prolonged as compared with those in Cg, in which psychometric tests and N 50 peak latency gradually worsened during the follow up After 8 weeks of treatment, psychometric tests, BA and N 50 peak latency were significantly improved in Stg, but at week 24 they were deteriorated after cessation of treatment The development of clinical hepatic encephalopathy was more frequent in Cg (40%) and Stg (30%) than in Ltg (5%) One patient each was not followed up after week 24 in Cg and Stg, respectively and 2 patients in Ltg stopped lactulose because of severe diarrhea Conclusions In patients with SHE, long term treatment with lactulose could lower BA, improve psychometric tests , prevent SEP from getting worse, and eventually cut down the occurrence rate of clinical hepatic encephalopathy.