门冬氨酸鸟氨酸联合醒脑静治疗肝性脑病患者疗效及其对血清炎症因子水平的影响

目的 探讨应用门冬氨酸鸟氨酸联合醒脑静治疗乙型肝炎肝硬化并发肝性脑病(HE)患者的疗效及其对认知功能和血清炎症因子水平的影响。方法 将62例乙型肝炎肝硬化并发HE患者随机分为观察组31例和对照组31例,在常规治疗的基础上分别给予醒脑静或醒脑静联合门冬氨酸鸟氨酸静脉滴注,两组均持续治疗2周。采用ELISA法检测血清白介素-6(IL-6)、C-反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)水平,应用数字连接试验(NCT)、数字符号试验(DS)、简易智力状态检查量表(MMSE)和长谷川痴呆量表(HDS)行认知功能评价。结果 在治疗2周末,观察组病死率为19.4%,显著低于对照组的35.5%(P<0.05);治疗后,观察组MMSE评分为(28.1±3.2)分,显著高于对照组【(22.1±2.8)分,P<0.05】,HDS评分为(27.7±2.6)分,显著高于对照组【(19.0±2.1)分,P<0.05】,DS评分为(60.7±1.9)分,显著高于对照组【(43.1±4.0)分,P<0.05】,而NCT用时为(51.6±5.9)s,显著短于对照组【(62.4±6.5)s,P<0.05】;观察组血清IL-6水平为(11.8±0.9)ng/L,显著低于对照组【(14.9±1.0)ng/L,P<0.05】,血清CRP水平为(13.6±1.7)ng/L,显著低于对照组【(15.5±1.9)ng/L,P<0.05】,血清TNF-α水平为(12.0±1.0)ng/L,显著低于对照组【(15.9±1.2)ng/L,P<0.05】;观察组血氨(NH₃)水平为(54.9±5.6)μmol/L,显著低于对照组【(85.3±8.7)μmol/L,P<0.05】,而两组血清胆红素和白蛋白水平差异无统计学意义(P>0.05)。结论 应用门冬氨酸鸟氨酸联合醒脑静治疗乙型肝炎肝硬化并发HE患者有一定的效果,在综合治疗的基础上可降低近期病死率,可能与有效地抑制了机体的炎症反应,降低血NH₃水平有关,其远期疗效仍有待于进一步观察。

Short-term efficacy of ornithine aspartate and a herbal compound combination in treatment of patients with hepatitis B liver cirrhosis complicated by hepatic encephalopathy

Objective The aim of this study was to observe the short-term efficacy of ornithine aspartate and a herbal compound,Xingnaojing,combination in treatment of patients with hepatitis B liver cirrhosis(LC) complicated by hepatic encephalopathy(HE). Methods 62 hepatitis B-induced LC patients with HE were randomly divided into observation(n = 31)and control group(n = 31). The patients in the control group were treated with Xingnaojing,and those in the observation group were treated with ornithine aspartate at the basis of treatment in the control group. The regimen in both groups lasted for 2 weeks. Serum interleukin-6(IL-6),C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) were detected by ELISA,and the cognitive functions were evaluated by number connection test(NCT),digital symbol(DS),mini-mental state examination(MMSE) and Hasegawa dementia scale(HDS). Results At the end of two week treatment,the fatality rate in observation group was 19.4%,significantly lower than 35.5%(P<0.05) in the control;after discontinuation of the regimen,the MMSE score in the observation was(28.1±3.2),significantly higher than 【(22.1± 2.8),P< 0.05】,the HDS score was(27.7± 2.6),significantly higher than 【(19.0±2.1),P<0.05】,the DS score was(60.7±1.9),much higher than 【(43.1±4.0),P<0.05】,while the time of NCT was(51.6±5.9) s,significantly shorter than 【(62.4±6.5) s,P<0.05】in the control;serum IL-6 level in the observation was(11.8±0.9) ng/L,much lower than 【(14.9±1.0) ng/L,P<0.05】,serum CRP level was(13.6±1.7) ng/L,significantly lower than 【(15.5±1.9) ng/L,P<0.05】,and serum TNF-αlevels was(12.0±1.0) ng/L,significantly lower than 【(15.9±1.2) ng/L,P < 0. 05 】 in the control;blood ammonia level in the observation was(54.9 ± 5.6) μmol/L,significantly lower than【(85.3±8.7) μmol/L,P<0.05】in the control,while there were no significant differences as respect to total serum bilirubin and albumin levels between the two groups(P < 0. 05). Conclusion The use of isophanate ornithine and Xingnaojing combination is effective in the treatment of patients with LC and HE,which might inhibit the inflammatory reaction and decrease blood NH3 levels.