幽门螺旋杆菌感染与肝硬化高氨血症及肝性脑病发病的相关性研究

目的 了解幽门螺旋杆菌(HP)感染与血氨水平及肝性脑病(HE)发病的相关性,探讨根除HP对血氨水平和HE发病的影响.方法 收集368例肝硬化患者,记录其性别、年龄、数字连接试验(NCT)结果、HP感染率、肝功能Child-Pugh分级、血氨水平和HE情况.HP阳性患者予以奥美拉唑+克拉霉素+阿莫西林1周根除治疗,1个月后复查13C尿素呼气试验,记录患者的神经、精神症状和血氨水平.结果 ①本组肝硬化患者的HP感染率为70.1%(258/368例);HE发生率为51.4%(189/368例);未发生HE的肝硬化患者中,179例进行了NCT,检出亚临床肝性脑病(SHE)患者85例(占47.5%).②HP阳性肝硬化患者血氨浓度(79.3±61.8)μmol/L]显著高于HP阴性者(52.7±49.8)μmol/L,P＜0.01];根除HP后血氨水平明显下降(52.6±36.5)μmol/L,P＜0.01].HP阳性和HP阴性肝硬化患者HE发生率比较差异有显著性(59.6%比31.8%,P＜0.01);根除HP后HE发生率降至32.8%,与根除前比较差异有显著性(P＜0.01).③HE、SHE和肝硬化患者的HP感染率分别为81.5%、68.5%和53.9%(P均＜0.05),HE患者的血氨水平(96.6±78.2)μmol/L]显著高于SHE患者(60.5±50.4)μmol/L]和肝硬化患者(46.8±36.4)μmol/L,P均＜0.01].结论 HP感染可加重肝硬化高氨血症,促成HE发作,根除HP有助于治疗和预防肝硬化HE发生.

Study of correlation between helicobacter pylori infection and hyperammonemia and hepatic encephalopathy in cirrhotic patients

OBJECTIVE: To evaluate the relationship among helicobacter pylori (HP) infection, blood ammonia concentrations, and hepatic encephalopathy (HE) status, and to investigate the effect of HP eradication on blood ammonia levels and HE status in cirrhotic patients. METHODS: Three hundred and sixty-eight cirrhotic patients were enrolled. Patients were evaluated for the demographic profile, number connection test (NCT), HP infection, Child-Pugh degree of liver dysfunction, blood ammonia concentration and status of mentation. Patients with HP infection were given one week therapy with omeprazole plus clarithromycin and amoxicillin. (13)C urea breath test was performed, and the mental symptoms and blood ammonia levels were reassessed after the eradication therapy. RESULTS: (1) The overall HP infection rate was 70.1% (258/368 cases), and HE positive in 51.4%(189/368 cases). Subclinical hepatic encephalopathy (SHE) was diagnosed in 85 out of 19(47.5%) cirrhotics patients. (2) Blood ammonia concentrations in HP negative and HP positive cirrhotics were (52.7+/-49.8)micromol/L and (79.3+/-61.8)micromol/L, respectively (P<0.01), and it was significantly reduced to (52.6+/-36.5) micromol/L after HP eradication therapy (P<0.01). HE was more frequently found in patients with HP infection than without it (59.6% vs. 31.8%, P<0.01). HE rate were significantly dropped to 32.8% after HP eradication (P<0.01). (3)HP prevalence rate was significantly different among cirrhotics with HE (81.5%),those with SHE (68.5%), or without HE (53.9%)(P<0.05). The level of blood ammonia had significantly difference among the cirrhotics with HE (96.6+/-78.2)micromol/L], those with SHE (60.5+/-50.4)micromol/L], or without HE(46.8+/-36.4)micromol/L, both P<0.05]. CONCLUSION: HP infection aggravates elevated blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. HP eradication may be helpful in the treatment and prevention of HE in cirrhotic patients.