门冬氨酸鸟氨酸联合纳洛酮对肝性脑病患者肝功能、认知功能、血氨及β-内啡肽水平的影响  

Effect of ornithine aspartate combined with naloxone on the liver function,cognitive function,plasma ammonium and β-endorphin of patients with hepatic encephalopathy

作　　者：刘国梁 徐静 赖鑫 占晗琳 

机构地区：[1]江西省鹰潭市人民医院消化内科,江西鹰潭335000 [2]江西省鹰潭市人民医院肾内科,江西鹰潭335000 [3]江西省鹰潭市人民医院检验科,江西鹰潭335000

出　　处：《实用临床医药杂志》2015年第17期41-44,共4页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11522721)

摘　　要：目的探讨门冬氨酸鸟氨酸联合纳洛酮对肝性脑病患者肝功能、认知功能、血氨及β-内啡肽(β-EP)水平的影响。方法将85例肝性脑病患者随机分为观察组43例和对照组42例。2组均给予常规治疗,在此基础上,观察组静脉滴注门冬氨酸鸟氨酸及纳洛酮。观察2组治疗前及治疗7 d后谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转移酶(γ-GT)、总胆红素(TBIL)及血氨和血浆β-EP水平的变化,比较神志清醒时间及治疗3 d后的尿量,并观察认知功能的改善情况。结果治疗7 d后,2组AST、ALT、γ-GT、TBIL及血氨和血浆β-EP水平均较治疗前明显降低(P<0.01),其中观察组降低幅度显著大于对照组;与对照组相比,观察组神志清醒时间更短,且尿量<1 000 m L的患者更少(P<0.05或P<0.01);治疗7 d后,2组数字连接试验(NCT)结果较治疗前明显降低(P<0.01),而数字符号试验(DST)明显升高(P<0.01),其中观察组降低及升高幅度均显著大于对照组(P<0.01)。结论门冬氨酸鸟氨酸联合纳洛酮不仅能有效降低肝性脑病患者血氨及血浆β-EP水平,还可改善肝功能,加速神志清醒,提高认知功能。Objective To explore the effect of ornithine aspartate combined with naloxone on the liver function, cognitive function, plasma ammonium and β-endorphin （β-EP） of patients with hepatic encephalopathy （HE）. Methods Eighty-five patients with HE were randomly divided into observation group （ n = 43） and control group （ n = 42）. Both groups were given routine treatment. Based on this, observation group was intravenously injected ornithine aspartate and naloxone. The changes of aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, γ- glycosyltransferase （GT）, total bilirubin （TBIL）, plasma ammonium and β-EP in two groups were observed before and 7 d after treatment, and consciousness time, urine output 3 d after treatment and improvement of cognitive function were also compared. Results 7 d after treatment, the levels of AST, ALT, γ-GT, TBIL, plasma ammonium and β-EP all went down obviously in both groups compared with treatment before （P 〈 0.01 ）, in which the decreased range in observation group was larger than in control group. Compared with control group, the consciousness time in observation group was shorter, and the patients with urine output 〈 1 000 mL less （P 〈 0.05 or P 〈0. 01）. Compared with treatment before, the results of number-connecting-test （NCT） decreaseddramatically in two groups （ P 〈 0.01 ） , while those of digit symbol test increased 7 d after treatment （ P 〈 0 . 0 1 ） , in which the decreased and increased ranges of observation group were more significant （P 〈 0. 01）. Conclusion For the patients with HE, ornithine aspartate combined with naloxone can effectively reduce the levels of plasma ammonium and β-EP, ameliorate liver function, accelerate consciousness and improve the cognitive function.

关 键 词：门冬氨酸 鸟氨酸 纳洛酮 肝性脑病 内啡肽 

分 类 号：R742[医药卫生—神经病学与精神病学]