Zullo A, Rinaldi V, Meddi P, Hassan C, Winn S, Attili A F
Department of Clinical Medicine, Gastroenterology II, La Sapienza University, Rome, Italy.
Am J Gastroenterol. 1999 Aug;94(8):2214-8. doi: 10.1111/j.1572-0241.1999.01295.x.
The role of Helicobacter pylori (H. pylori) infection as a cause of hepatic encephalopathy is still debated. This study focused on the relationship between H. pylori, plasma ammonia levels, and intellectual function in cirrhotic patients.
Forty-seven cirrhotics with latent or mild hepatic encephalopathy were enrolled in the study, upon H. pylori assessment at endoscopy. Plasma ammonia level determinations and psychometric testing were performed at entry in all patients. Patients with H. pylori infection received a 2-wk standard dual therapy and bacterial eradication was assessed at endoscopy 6-8 wk later. On this occasion, plasma ammonia levels and psychometric assessments were repeated. Patients without H. pylori infection at entry were also studied after 6-8 wk for ammonia level assessment and psychometric testing, as a control group. Patients receiving lactulose therapy and those without therapy were grouped separately for statistical analysis.
Among 21 patients without lactulose therapy (group A), basal plasma ammonia levels and psychometric testing scores did not significantly differ between 13 infected and eight uninfected patients. Similarly, among 26 patients undergoing lactulose therapy (group B), basal plasma ammonia concentration and psychometric testing scores did not significantly differ between 13 infected and 13 uninfected patients. Moreover, in group B, both the prevalence of previous overt hepatic encephalopathy episodes and the mean daily dose of lactulose therapy were similar between infected and uninfected patients. In addition, no significant reduction in the plasma ammonia concentrations and in psychometric testing scores emerged in both groups A and B after bacterial eradication.
This study failed to find a relationship between H. pylori, plasma ammonia levels, and psychometric testing scores in cirrhotic patients with latent or mild hepatic encephalopathy.
幽门螺杆菌（H. pylori）感染作为肝性脑病病因的作用仍存在争议。本研究聚焦于肝硬化患者中幽门螺杆菌、血浆氨水平与智力功能之间的关系。
47例有潜在或轻度肝性脑病的肝硬化患者在内镜检查时接受幽门螺杆菌评估后纳入研究。所有患者在入组时进行血浆氨水平测定和心理测量测试。幽门螺杆菌感染患者接受为期2周的标准双重治疗，并在6 - 8周后通过内镜检查评估细菌根除情况。此时，重复进行血浆氨水平和心理测量评估。入组时未感染幽门螺杆菌的患者在6 - 8周后也进行氨水平评估和心理测量测试，作为对照组。接受乳果糖治疗和未接受治疗的患者分别分组进行统计分析。
在21例未接受乳果糖治疗的患者（A组）中，13例感染患者和8例未感染患者的基础血浆氨水平和心理测量测试分数无显著差异。同样，在26例接受乳果糖治疗的患者（B组）中，13例感染患者和13例未感染患者的基础血浆氨浓度和心理测量测试分数也无显著差异。此外，在B组中，感染患者和未感染患者既往显性肝性脑病发作的患病率以及乳果糖治疗的平均每日剂量相似。另外，A组和B组在细菌根除后血浆氨浓度和心理测量测试分数均未出现显著降低。
本研究未能发现潜在或轻度肝性脑病的肝硬化患者中幽门螺杆菌、血浆氨水平和心理测量测试分数之间存在关联。
