乳果糖治疗对亚临床肝性脑病患者生存质量的影响

目的　对亚临床肝性脑病 (SHE)患者进行乳果糖长短程治疗以比较其对SHE生存质量的影响。方法　60例经数字连接试验 (NCT) ,数字符号试验 (DST)和 (或 )诱发电位检查异常并配合治疗的SHE患者随机分配入对照组、乳果糖短程治疗组及长程治疗组中 ,每组各 2 0例。对照组仅给予VitBco治疗 2 4周 ,短程治疗组另再给予口服乳果糖治疗 8周 ,长程治疗组则另再给予口服乳果糖至 2 4周。分别在第 0 ,8,16,2 4周末作血氨、生存质量 (WHOQOL -BREF中国版 )检查并观察肝性脑病 (HE)发病率。结果　①治疗后 3组间比较在生存质量的环境领域差异无显著性 (P >0 0 5 ) ,但在血氨、生存质量的生理、心理、社会关系领域差异均有显著性 (P <0 0 5 ) :其中第 8周 ,长程、短程组均较对照组有明显改善 (P <0 0 5 ) (血氨除外 ,P >0 0 5 ) ,长短程组之间差异无显著性 (P >0 0 5 ) ;第 16周 ,长程组均较对照组和短程组有明显改善 (P <0 0 5 ) ,短程组和对照组之间差异无显著性 (P >0 0 5 ) ;第 2 4周 ,长程组均明显好于对照组和短程组 (P <0 0 5 ) ,短程组和对照组之间差异无显著性 (P >0 0 5 )。②随访 2 4周 ,对照组、短程组、长程组肝性脑病累计发病率分别为 40 % ,3 0 % ,5 % ,长程组较对照组及短程组均有显著性降低

The effects of lactulose on quality of life in subclinical hepatic encephalopathy

Objective To compare the effects of long-term and short-term treatment of lactulose on the quality of life in patients with subclinical hepatic encephalopathy (SHE).Methods 60 SHE patients with abnormal psychometric tests were randomly divided into 3 groups to observe the effect of long-term and short-term treatment with lactulose on quality of life in patients with SHE. Patients in control group were given vitamine Bco only for 24 weeks. Patients in short-term group were administered lactulose for 8 weeks in addition to vitamine Bco for 24 weeks, the patients in long-term group were administered with lactulose in addition to vitamine Bco for 24 weeks. Venous blood ammonia concentration was measured and quality of life was assessed by WHOQOL-BREF. The prevalence of HE was recorded.Results After therapy, no significant difference was found in the score of ENVER ( P >0 05) among 3 groups, but significant differences were found in blood ammonia, score of PHYS, PSYCH and SCOIL ( P <0 05). At the 8th week, the long-term and short-term groups were better than the controls ( P <0 05) (except for blood ammonia, P >0 05). No significant differences were found between the long-term and short-term groups ( P >0 05). At the 16th week, the long-term group were better than the controls and the short-term group in blood ammonia, score of PHYS, PSYCH and SCOIL ( P <0 05). However no significant difference was found between controls and the short-term group ( P>0 05).At the 24th week, the long-term group was still better than the controls and the short-term group ( P <0 05). However, no significant difference was found between the controls and the short-term group ( P >0 05). The prevalence of hepatic encephalopathy in control group, short-term and long-term groups were 40%, 30% and 5% respectively after 6 months. No significant difference ( P >0 05) was found between control and short-term groups. However, significant difference was found between control and long-term group ( P <0 01) and between short-term and long-term group ( P <0 05).Conclusion Long-term treatment of lactulose can lower blood ammonia, improve quality of life, and eventually reduce the prevalence of clinical HE. However, short-term treatment of lactulose can not improve SHE.