幽门螺杆菌的根治对肝硬化患者血氨的影响

目的评价肝硬化患者Hp感染状况对血氨浓度的影响。方法对46例肝硬化伴高血氨患者的血液以及胃液中氨浓度进行分析，所有患者给予低蛋白饮食、卡那霉素、乳果糖以及丰富的支链氨基酸溶液治疗，其中24例患者仍有高血氨，根据Hp感染分布的状况，把24例患者分成三组：Hp在胃中弥漫性分布的患者为Ⅰ组，Hp在胃中局部分布的患者为Ⅱ组，Hp阴性的患者为Ⅲ组。24例患者均给予口服10mg雷贝拉唑，1000mg阿莫西林以及400mg克拉霉素或500mg甲硝唑2周进行Hp的根治。结果第Ⅰ组Hp根治后血液以及胃液中血氨浓度明显下降，Hp根治12周后血氨浓度明显降低（P〈0．05），第Ⅱ组、Ⅲ组进行Hp根治后血氨浓度未见明显降低。结论胃中Hp弥漫性感染是导致肝硬化患者血氨升高的原因之一，针对Hp弥漫性分布的肝硬化患者，必须进行有效的Hp根治。

Effects of the eradication of H pylori in patients with liver cirrhosis and hyperammonaemia

Objective This study aimed to evaluate whether ammonia levels were influenced by H pylori status in a series of 46 cirrhotic patients.Methods Ammonia concentrations in blood and gastric juice were analysed in 46 patients with liver cirrhosis and hyperammonaemia.All patients were first treated with a low protein diet,kanamycin,lactulose,and branched chain enriched amino acid solution.Hyperammonaemia remained in 24 patients.These 24 patients were divided into three groups according to the status of H pylori infection,those with a diffuse distribution of H pylori in the stomach(group I),those with a regional distribution(group II),and those without H pylori(group III).These patients were given 10 mg rabeprazole,1000 mg amoxicillin, and 400 mg clarithromyc in or 500 mg metronidazole for two weeks to eradicate H pylori.Results In group I ammonia concentrations in blood and gastric juice were significantly reduced after H pylori eradication(P<0.05).The blood ammonia concentration at 12 weeks after the eradication was still significantly lower than that before eradication.In groups II and III the ammonia concentrations in blood and gastric juice were not significantly reduced after eradication therapy.Conclusion The diffuse distribution of H-pylori in the stomach contributes partly to hyperammonaemia in patients with liver cirrhosis,and the eradication of H pylori is effective in patients with hyperammonaemia with diffuse H pylori infection in the stomach.