Wang Liang-jing, Cai Jian-ting, Chen Tao, Lü Bin, Si Jian-min
Department of Gastroenterology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
Zhonghua Nei Ke Za Zhi. 2006 Aug;45(8):654-7.
To evaluate the relationship among Helicobacter pylori (Hp)infection, blood ammonia concentrations, and hepatic encephalopathy (HE) status, and to investigate the effect of Hp eradication on blood ammonia levels and hepatic encephalopathy status in cirrhotic patients.
From July 2003 to Jan 2005, cirrhotic patients in 5 regions of Zhejiang Province were enrolled. Patients were evaluated for the demographic checklists, number connection test, Hp infection, liver impairment level, blood ammonia concentrations and hepatic encephalopathy status. Patients with Hp infection were given one week therapy with omeprazole plus clarithromycin and tinidazole. (14)C urea breath test was performed and the mental symptoms and blood ammonia levels were reassessed after the eradication therapy.
(1) 457 cirrhotics were enrolled, the overall Hp infection rate was 60.6%, and HE happened with 47.5%. Subclinical hepatic encephalopathy (SHE) were detected 55 in 47.0% of 117 cirrhotics. (2) Blood ammonia concentration in Hp (-) and Hp (+) cirrhotics was (53.8 +/- 51.4) micromol/L and (78.4 +/- 63.6) micromol/L respectively (P < 0.01), which was significantly reduced to (53.5 +/- 37.7) micromol/L after Hp eradication (P < 0.01). HE was more frequently observed in patients with Hp infection than without it (58.5% vs 30.6%, P < 0.01). HE rate were significantly dropped to 34.1% after Hp eradication (P < 0.01). (3) Hp prevalence significantly differed among cirrhotic with HE (74.4%), those with SHE (69.1%), or without HE (53.2%) (P < 0.05). The level of blood ammonia had significant difference among the cirrhotics with HE (94.5 +/- 75.6) micromol/L, those with SHE (59.9 +/- 49.2) micromol/L, or without HE (47.3 +/- 33.5) micromol/L (P < 0.05).
Hp infection was an important factor of inducing with high blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. Hp eradication may be helpful for treatment and prevention of HE.
评估幽门螺杆菌（Hp）感染、血氨浓度与肝性脑病（HE）状态之间的关系，并探讨根除Hp对肝硬化患者血氨水平和肝性脑病状态的影响。
选取2003年7月至2005年1月浙江省5个地区的肝硬化患者。对患者进行人口统计学清单、数字连接试验、Hp感染、肝功能损害程度、血氨浓度及肝性脑病状态评估。对Hp感染患者给予奥美拉唑联合克拉霉素和替硝唑治疗1周。根除治疗后进行（14）C尿素呼气试验，并重新评估精神症状和血氨水平。
（1）共纳入457例肝硬化患者，总体Hp感染率为60.6%，HE发生率为47.5%。在117例肝硬化患者中，47.0%（55例）检测到亚临床肝性脑病（SHE）。（2）Hp（-）和Hp（+）肝硬化患者的血氨浓度分别为（53.8±51.4）μmol/L和（78.4±63.6）μmol/L（P<0.01），根除Hp后显著降至（53.5±37.7）μmol/L（P<0.01）。Hp感染患者中HE的发生率高于未感染患者（58.5%对30.6%，P<0.01）。根除Hp后HE发生率显著降至34.1%（P<0.01）。（3）HE肝硬化患者（74.4%）、SHE肝硬化患者（69.1%）和无HE肝硬化患者（53.2%）的Hp感染率有显著差异（P<0.05）。HE肝硬化患者（94.5±75.6）μmol/L、SHE肝硬化患者（59.9±49.2）μmol/L和无HE肝硬化患者（47.3±33.5）μmol/L的血氨水平有显著差异（P<0.05）。
Hp感染是肝硬化患者血氨浓度升高和肝性脑病的重要诱发因素。根除Hp可能有助于HE的治疗和预防。
