Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
Saudi J Gastroenterol. 2011 Mar-Apr;17(2):138-41. doi: 10.4103/1319-3767.77246.
BACKGROUND/AIM: Hepatic encephalopathy (HE) is associated with a poor prognosis. There is paucity of data on the treatment of HE with lactulose in children with cirrhosis.
Retrospective analysis of consecutive cirrhotic patients (<18 years) with HE was done. HE was defined according to West-Haven criteria. Response was defined as complete if patients recovered completely from HE, partial response was defined as improvement of encephalopathy by one or more grades from admission but not complete recovery, and defined as non response if patient did not show any improvement or deteriorated further even after 10 days of lactulose therapy.
A total of 300 patients were admitted with cirrhosis and HE (278 adults and 22 children). Of 22 patients, 16 (73%) patients had complete response to lactulose and six (27%) patients did not [three (13.5%) patients worsened (non response) and three (13.5%) did not recover fully even after 10 days of treatment (partial response)]. Comparing baseline characteristics of patients who had complete response (n=16) versus partial (n=3) and non response (n=3), there was significant difference in mean arterial pressure (78.1±10.7 vs 62.6±5.0 mmHg, P=0.003), serum sodium (131.3±3.2 vs 126.5±5.2, P=0.01) and serum creatinine (0.78±0.3 vs 1.1±0.3 mg/dl, P=0.02). We did not find any difference in baseline characteristics of these patients regarding CTP score (9.6±1.2 vs 10.6±1.2), MELD score (17.6±2.9 vs 17.1±3.4), severity of HE (2.5±0.6 vs 2.6±0.5) and etiology of precipitating factors (P=0.78).
Lactulose therapy causes complete recovery from hepatic encephalopathy in 73% of pediatrics patients with cirrhosis.
背景/目的：肝性脑病（HE）与预后不良有关。关于肝硬化儿童使用乳果糖治疗 HE 的数据很少。
对连续的肝硬化患者（<18 岁）进行回顾性分析。根据 West-Haven 标准定义 HE。完全缓解定义为患者完全从 HE 中恢复，部分缓解定义为入院后脑病程度提高一级或一级以上但未完全恢复，无反应定义为即使在乳果糖治疗 10 天后患者无任何改善或进一步恶化。
共有 300 例肝硬化伴 HE 的患者（278 例成人和 22 例儿童）入院。22 例患儿中，16 例（73%）对乳果糖有完全反应，6 例（27%）无反应[3 例（13.5%）恶化（无反应），3 例（13.5%）即使治疗 10 天后也未完全恢复（部分反应）]。比较完全缓解（n=16）、部分缓解（n=3）和无反应（n=3）患者的基线特征，平均动脉压（78.1±10.7 与 62.6±5.0mmHg，P=0.003）、血清钠（131.3±3.2 与 126.5±5.2，P=0.01）和血清肌酐（0.78±0.3 与 1.1±0.3mg/dl，P=0.02）有显著差异。我们没有发现这些患者在 CTP 评分（9.6±1.2 与 10.6±1.2）、MELD 评分（17.6±2.9 与 17.1±3.4）、HE 严重程度（2.5±0.6 与 2.6±0.5）和诱发因素的病因方面有任何差异（P=0.78）。
乳果糖治疗可使 73%的肝硬化儿童肝性脑病完全恢复。
