Alexander T, Thomas K, Cherian A M
Department of Medicine, Christian Medical College, Vellore.
Indian J Med Res. 1992 Oct;96:292-6.
Neomycin (700 mg/8 h), ampicillin (500/6 h) and metronidazole (400 mg/8 h), were compared for their effect, on oral administration for 4 days, in reducing blood ammonia in 27 patients with stable chronic liver disease. It was found that there was 38.2, 38.5 and 8.7 m mol/litre mean reduction in blood ammonia in the neomycin, ampicillin and metronidazole treated groups respectively. The difference in blood ammonia was statistically significant for both neomycin (P = 0.01) and ampicillin (P = 0.03) but there was no significant change after metronidazole treatment (P = 0.6). The total stool enzyme activity at optimum pH was maximally reduced by ampicillin and minimally with metronidazole. The reduction was noted to be 3.51 m mol/1 (P = 0.01), 3.87 m mol/1 (P = 0.08) and 2.8 m mol/1 (P = 0.02) of NH3/g dry weight of stool for neomycin, ampicillin and metronidazole respectively. The main bacterial gut enzymes responsible for ammonia production, urease and protease, were found to be very sensitive to stool pH. At pH 6 their activity was around 20 per cent of what was found in optimum pH of 7.4 and at pH 5 it is only about 8 per cent of optimum activity. None of the three antibacterial agents changed the stool pH significantly. It can be concluded that oral neomycin and ampicillin are superior to oral metronidazole in lowering blood ammonia.
对27例稳定期慢性肝病患者口服新霉素（700毫克/8小时）、氨苄西林（500毫克/6小时）和甲硝唑（400毫克/8小时）4天，比较它们降低血氨的效果。结果发现，新霉素、氨苄西林和甲硝唑治疗组的血氨平均降低值分别为38.2、38.5和8.7微摩尔/升。新霉素（P = 0.01）和氨苄西林（P = 0.03）治疗后血氨差异有统计学意义，但甲硝唑治疗后无显著变化（P = 0.6）。在最适pH值下，粪便总酶活性最大降低值出现在氨苄西林治疗组，最小降低值出现在甲硝唑治疗组。新霉素、氨苄西林和甲硝唑治疗组每克干粪便中NH₃的降低值分别为3.51微摩尔/克（P = 0.01）、3.87微摩尔/克（P = 0.08）和2.8微摩尔/克（P = 0.02）。发现肠道中负责产生氨的主要细菌酶脲酶和蛋白酶对粪便pH值非常敏感。在pH值为6时，它们的活性约为最适pH值7.4时的20%，在pH值为5时，仅约为最适活性的8%。三种抗菌药物均未显著改变粪便pH值。可以得出结论，口服新霉素和氨苄西林在降低血氨方面优于口服甲硝唑。
