轻微型肝性脑病的危险因素及乳果糖疗效研究

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1214 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨肝硬化患者发生轻微型肝性脑病(MHE)的影响因素,研究乳果糖治疗MHE的效果。方法选取2018年9月—2020年12月就诊于山东第一医科大学附属消化病医院的246例肝硬化患者。通过数字连接实试验-A(NCT-A)和数字符号试验(DST)对MHE进行筛查,分析发生MHE的危险因素,研究乳果糖对MHE的治疗效果。结果血氨(P<0.001)、血清白蛋白(P=0.002)、凝血酶原时间(P<0.001)、血钙(P=0.005)、血钠(P<0.001)、腹水史(P=0.043)、上消化道出血史(P=0.002)是发生MHE的独立危险因素。乳果糖治疗MHE可改善病人NCT-A(t=2.363,P=0.020)、DST(t=2.369,P=0.020)测试结果。结论临床上应密切监测与MHE发生相关的危险因素。一旦发生MHE,可应用乳果糖进行治疗。　

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张茜茜
	赵士兴
	王登芹
	赵会丽
	邓现培

关键词 ：轻微型肝性脑病, 肝硬化, 危险因素, 治疗

Abstract：Objective To explore the risk factors of mild hepatic encephalopathy (MHE) in patients with liver cirrhosis, and study the effect of lactulose on MHE. Methods A total of 246 patients with cirrhosis were selected in Digestive Diseases Hospital of Shandong First Medical University from September 2018 to December 2020. MHE was screened by the number connection test A (NCT-A) and digital symbol test (DST). Clinical data were analyzed to determine the risk factors of MHE and to study the therapeutic effect of lactulose. Results Blood ammonia (P<0.001), serum albumin (P=0.002), prothrombin time (P<0.001), serum calcium (P=0.005), serum sodium (P<0.001), ascites history (P=0.043) and upper gastrointestinal bleeding history (P=0.002) were independent risk factors for MHE. Lactulose treatment in MHE patients could improve the results of NCT-A (t=2.363, P=0.020) and DST (t=2.369, P=0.020). Conclusions The risk factors of MHE should be monitored closely. Once MHE occurs, the patients can be treated with lactulose.

Key words： mild hepatic encephalopathy (MHE) liver cirrhosis risk factor treatment

收稿日期: 2021-05-06

ZTFLH:

R657.3+1

基金资助:山东省自然科学基金(ZR2017BH056)

作者简介: 张茜茜(1987-),女,山东济宁人,讲师,研究生,博士,研究方向为肝脏疾病的临床和基础研究。

引用本文:

张茜茜,赵士兴,王登芹,赵会丽,邓现培. 轻微型肝性脑病的危险因素及乳果糖疗效研究[J]. 中国校医, 2022, 36(5): 350-354.
ZHANG Qian-qian, ZHAO Shi-xing, WANG Deng-qin, ZHAO Hui-li, DENG Xian-pei. Study on risk factors and therapeutic effect of lactulose in mild hepatic encephalopathy. Chinese Journal of School Doctor, 2022, 36(5): 350-354.

链接本文:

https://www.zgxyzz.org.cn/CN/ 或 https://www.zgxyzz.org.cn/CN/Y2022/V36/I5/350

[1] Blei AT,Córdoba J,Practice Parameters Committee of the AmericanCollege of Gastroenterology.Hepatic Encephalopathy[J]. Am J Gas-troenterol,2001,96(7):1968-1976.
[2] Ridola L,Riggio O,Gioia S,et al. Minimal hepatic encephalopathyand sleep disorders in patients with cirrhosis:Which comes first[J]. Saudi J Gastroenterol,2020,26(3):111-112.
[3] Weissenborn K.Hepatic encephalopathy:definition,clinical gradingand diagnostic principles[J]. Drugs,2019,79(Suppl 1):5-9.
[4] Mullen KD,Prakash RK.Management of covert hepatic encephalopa-thy[J]. Clin Liver Dis,2012,16(1):91-93.
[5] Schulz C,Schütte K,Kropf S,et al.RiMINI-the influence of rifaximinon minimal hepatic encephalopathy (MHE) and on the intestinalmicrobiome in patients with liver cirrhosis:study protocol for arandomized controlled trial[J]. Trials,2016,17(1):111.
[6] 中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].实用肝脏病杂志,2020,23(1):S9-S32.
[7] 中华医学会消化病学分会,中华医学会肝病学分会.中国肝性脑病诊治共识意见(2013年,重庆)[J].中国医学前沿杂志(电子版),2014,6(2):81-93.
[8] Weissenborn K,Ennen JC,Schomerus H,et al. Neuropsychologicalcharacterization of hepatic encephalopathy[J]. J Hepatol,2001,34(5):768-773.
[9] 郭琲婷,郭晓霞.轻微型肝性脑病的研究进展与中医治疗[J].世界中医药,2017,12(10):2522-2526.
[10] 保志军,邱德凯,马雄,等.简易智能测试在诊断轻微肝性脑病中的初步应用[J].中华消化杂志,2006,26(9):606-609.
[11] Lauridsen MM,Thacker LR,White MB,et al. In Patients WithCirrhosis, Driving Simulator Performance Is Associated With Real-life Driving[J].Clin Gastroenterol Hepatol,2016,14(5):747-752.
[12] Souto PA,Marcotegui AR,Orbea L,et al.Hepatic encephalopathy:Ever closer to its big bang[J]. World J Gastroenterol,2016,22(42):9251-9256.
[13] 杨廷旭,高毅英,康发财,等.轻微肝性脑病区域性流行病学调查及中西医结合干预研究[J].中国临床研究,2015,28(4):540-542.
[14] Jeong JY,Jun DW,Bai D,et al. Validation of a paper and penciltest battery for the diagnosis of minimal hepatic encephalopathy inkorea[J]. J Korean Med Sci,2017,32(9):1484-1490.
[15] Thomsen KL,Macnaughtan J,Tritto G,et al.Clinical and pathophy-siological characteristics of cirrhotic patients with grade 1 andminimal[J]. PLoS One,2016,11(1):e0146076.
[16] Bajaj JS,Duarte-Rojo A,Xie JJ,et al. Minimal Hepatic Encepha-lopathy and Mild Cognitive Impairment Worsen Quality of Life inElderly Patients With Cirrhosis[J].Clin Gastroenterol Hepatol,2020,18(13):3008-3016.
[17] 李洁,赵江明,王黎,等.轻微型肝性脑病发病机制的研究进展[J].山东医药,2019,59(35):103-105.
[18] 陆伦根.肝性脑病:离我们并不遥远[J].中华消化杂志,2017,37(8):508-512.
[19] Prasad S,Dhiman RK,DusejaA,et al. Lactulose improves cognitivefunctions and health-related quality of life cirrhosis who haveminimal hepatic encephalopathy[J].Hepatology,2007,45(3):549-559.
[20] 郑雪玲,毕美霞. 4项生化指标检测在肝硬化与病毒性肝炎诊断中应用研究[J].中国校医,2021,35(2):114-119.
[21] Amodio P,Bemeur C,Butterworth R,et al. The nutritional mana-gement of hepatic encephalopathy in patients with cirrhosis:Intemalional Society for Hepatic Encephalathy and NjtrogenMetabolism Consensus[J]. Hepatology,2013,58(1):325-336.
[22] 张超群,谭诗云.肝硬化患者血钙水平与Child-Pugh 分级的关系[J].胃肠病学和肝病学杂志,2018,27(4):399-401.
[23] 朱龙川,朱萱.血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义[J].中华消化杂志,2016,36(3):161-166.
[24] 刘斌,张国顺,杨美荣,等.肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J].世界华人消化杂志,2016,24(18):2892-2897.
[25] 裴正浩.奥曲肽联合凝血酶治疗肝硬化合并上消化道出血的效果观察[J].中国校医,2020,34(6):434-473.