根除幽门螺杆菌对肝硬化患者血氨和脑电图变化的临床观察  

Clinical Observation of Helicobacter Pylori Eradication on Blood Ammonia Concentration and Electroencephalogram in Cirrhotic Patients

作　　者：陈范嵘[1] 杨蒲芳[1] 

机构地区：[1]上海市普陀区人民医院消化内科,上海200060

出　　处：《临床消化病杂志》2008年第6期367-368,370,共3页Chinese Journal of Clinical Gastroenterology

摘　　要：目的探讨肝硬化患者的幽门螺杆菌(Hp)感染情况并观察根除Hp后肝硬化患者血氨和脑电图的变化。方法确诊的肝硬化患者52例,经胃镜或14C尿素呼气试验明确Hp感染情况,对Hp阳性者进行Hp根除治疗(一周标准三联疗法),方案为奥美拉唑40mg/d,克拉霉素1.0g/d,阿莫西林2.0g/d,停药4周后复查14C尿素呼气试验,转阴性者判断为Hp根除,记录根除治疗前后血氨和脑电图情况。结果Hp阳性者血氨水平83.04±20.81mmol/L及脑电图异常发生率为86.1%,均明显高于Hp阴性者(P<0.01<);根除Hp后血氨水平49.10±9.80mmol/L及脑电图异常发生率3.1%,均明显下降(P<0.01)。结论Hp感染是引起肝硬化患者高血氨及脑电图异常的重要原因之一。根除Hp有助于治疗和预防肝性脑病。Objective To observe the efficacy of helicobacter pylori （Hp） eradication on blood ammonia concentration and electroencephalogram in liver cirrhotic patients. Methods 52 patients diagnosed with hepatic cirrhosis were enrolled. Hp was assessed by ^14C-urea breath test or histological examination. The patients with Hp infection received one-week standard triple therapy（ omerprazole 40 mg/d, clarithromyein 1.0 g/d, amoxicillin 2.0 g/d）. ^14C-urea breath test was performed 4 weeks later. If 14 C-urea test examination was negative it could be regarded as Hp eradication. Blood ammonia concentration and electroencepha- logram were tested before and after therapy. Results Blood ammonia concentration in Hp positive and Hp negative was 83.04 ±20. 81 mmol/L and 54. 03 ±7.28 mmoL/L respectively （ P 〈 0. 01 ）, which was significantly reduced to 49. 1 ± 9. 80 mmol/L after Hp eradication（ P 〈 0. 01 ）. The prevalence of electroencephalogram abnormality differecl Hp positive （86. 1% ） from Hp negative （ 18.8% ） （ P 〈 0. 01 ）, which was signiticanthy reduced （3.1% ） after Hp eradication （ P 〈 0. 01 ）. Conclusion Hp infection was one of important factors of inducing high blood ammonia concentration and electroencephalogram abnormality. In cirrhotic patients, Hp eradication may be helpful for treatment and prevention of hepatic encephalopathy.

关 键 词：肝硬化 血氨 幽门螺旋杆菌 脑电图 

分 类 号：R575.2[医药卫生—消化系统]