Shimamoto C, Hirata I, Katsu K
Second Department of Internal Medicine, Osaka Medical College, Japan.
Hepatogastroenterology. 2000 Mar-Apr;47(32):443-5.
BACKGROUND/AIMS: Hyperammonemia causes dysfunction of multiple organs in patients with cirrhosis, including hepatic encephalopathy. Blood ammonia concentrations are monitored with respect to disease progression and efficacy of treatment. Fetor hepaticus, the characteristic breath odor in hepatic encephalopathy has called little quantitative attention to breath ammonia. We studied the dynamics of ammonia metabolism in cirrhosis in terms of the relationship between breath and blood ammonia.
Breath and blood ammonia levels were measured simultaneously in 20 cirrhotic patients and in 10 healthy volunteers. Breath ammonia was measured using ammonia electrodes in collected expired air. Helicobacter pylori serum antibody titers were also measured, since the organism produces ammonia.
Blood ammonia correlated positively with breath ammonia in patients with cirrhosis. Breath ammonia levels were significantly higher in cirrhotic patients (0.745 ppm) than in controls (0.278 ppm), and higher in cirrhotic patients with hyperammonemia (0.997 ppm) than in those without (0.558 ppm). Breath and blood ammonia decreased together with treatment of hyperammonemia. H. pylori seropositivity was 20% in controls, 27.3% in cirrhotic patients with normal blood ammonia, and 66.7% in those with hyperammonemia.
Breath ammonia measurement may be useful in diagnosis, treatment assessment, and follow-up in hepatic encephalopathy.
背景/目的：高氨血症可导致肝硬化患者多器官功能障碍，包括肝性脑病。需根据疾病进展和治疗效果监测血氨浓度。肝臭，即肝性脑病特有的呼吸气味，对呼出气体中的氨缺乏定量关注。我们从呼出气体与血氨的关系方面研究了肝硬化患者氨代谢的动态变化。
对20例肝硬化患者和10名健康志愿者同时测量呼出气体和血氨水平。使用氨电极测量收集的呼出气体中的氨。由于幽门螺杆菌可产生氨，因此还测量了幽门螺杆菌血清抗体滴度。
肝硬化患者的血氨与呼出气体中的氨呈正相关。肝硬化患者呼出气体中的氨水平（0.745 ppm）显著高于对照组（0.278 ppm），高氨血症肝硬化患者呼出气体中的氨水平（0.997 ppm）高于无高氨血症患者（0.558 ppm）。随着高氨血症的治疗，呼出气体和血氨水平均下降。幽门螺杆菌血清阳性率在对照组为20%，血氨正常的肝硬化患者为27.3%，高氨血症患者为66.7%。
呼出气体氨测量可能有助于肝性脑病的诊断、治疗评估及随访。
