小肠细菌过度生长相关性轻微肝性脑病患者的血氨变化  

Plasma ammonia level in small intestinal bacteria overgrowth (SIBO) correlating minimal hepatic encephalopathy (MHE) in patients with cirrhosis

作　　者：张磊[1] 许涛[1] 刘世超[2] 曹彬[2] 

机构地区：[1]山东省新汶矿业集团华丰医院消化内科,山东泰安271413 [2]潍坊医学院

出　　处：《胃肠病学和肝病学杂志》2008年第6期453-455,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的观察肝硬化患者小肠细菌过度生长相关性轻微肝性脑病(MHE)患者的血氨水平,探讨血氨与轻微肝性脑病的关系。方法对90例肝硬化患者及20例健康志愿者进行血氨、葡萄糖氢呼气试验、数字连接试验和数字符号试验检测,观察小肠细菌过度生长相关性轻微肝性脑病患者的血氨水平差异。结果肝硬化组小肠细菌过度生长(36.7%,33/90)明显高于健康对照组(5%,1/20)。20名健康志愿者未检出MHE;90例肝硬化患者轻微肝性脑病37例(41.1%),其中伴小肠细菌过度生长肝硬化患者轻微肝性脑病发生率高于不伴小肠细菌过度生长患者。血氨水平均正常,但肝硬化组血氨水平高于健康对照组;肝硬化小肠细菌过度生长组血氨水平(47.9μmol/L±7.8μmol/L)高于无小肠细菌过度生长组(34.2μmol/L±6.8μmol/L,P<0.05);轻微肝性脑病组血氨水平(46.2μmol/L±5.9μmol/L)高于无轻微肝性脑病组(33.9μmol/L±7.6μmol/L,P<0.05)。应用抗生素抑制小肠细菌过度生长及乳果糖治疗1周后葡萄糖氢呼气试验(GHBT)、血氨水平、数字连接试验(NCT-A、NCT-BC)及数字符号试验(DST)检查结果改善。结论血氨对伴小肠细菌过度生长的轻微肝性脑病的发生及进展可能有一定的关系。Objective To observe the plasma ammonia level in small intestinal bacteria overgrowth（SIBO） correlating minimal hepatic encephalopathy（MHE） in cirrhotic patients and to investigate the relationship between plasma am-monia and minimal hepatic encephalopathy. Methods Ninety patients with confirmed liver cirrhosis and 20 healthy volunteers were selected. In all subjects, the plasma ammonia level was detected. Glucose hydrogen breath test （GH- BT） for SIBO was performed. And tests （NCT-A, NCT-BC and DST）for MHE were performed. Then the difference of plasma ammonia level in SIBO correlating MHE was observed. Results The rate of SIBO in cirrhotic patients（36.7% , 33/90） was higher than that in the healthy controls （5%, 1/20）. None was MHE in healthy volunteers. Thirty-seven （41.1%） were with MHE in cirrhotic patients. The plasma ammonia level was normal, but the plasma ammonia level with SIBO （47.9 μmol/L ± 7.8 μmol/L） was higher than that without SIBO （34.2 μmol/L ± 6.8 μmol/L, P 〈 0.05 ）. The plasma ammonia level with MHE（46.2 μmol/L ± 5.9 μmol/L） was higher than that without MHE（33.9 μmol/L ± 7.6 μmol/L,P 〈 0.05）. After one-week antibiotics and lactulose therapy, improvements in GHBT, the plasma ammonia level, psychometric testing scores were observed. Conclusion The role of the plasma ammonia was probably as cause of MHE with SIBO in cirrhotic patients.

关 键 词：血氨 肝硬化 小肠细菌过度生长 轻微肝性脑病 

分 类 号：R575[医药卫生—消化系统]