乳果糖在肝硬化并上消化道出血患者的肝性脑病预防中具有很大的潜力：一项对照随机试验的结果。
Lactulose is highly potential in prophylaxis of hepatic encephalopathy in patients with cirrhosis and upper gastrointestinal bleeding: results of a controlled randomized trial.
机构信息
Department of Gastroenterology and Hepatology, China PLA General Hospital, Beijing, PR China.
出版信息
Digestion. 2013;87(2):132-8. doi: 10.1159/000346083. Epub 2013 Mar 6.
BACKGROUND AND AIMS
Upper gastrointestinal bleeding (UGB) is an important precipitating factor for the development of hepatic encephalopathy (HE) in cirrhotic patients. The aim of this study was to evaluate the efficacy of lactulose in a controlled randomized trial for prophylaxis of HE after UGB.
PATIENTS AND METHODS
128 cirrhotic patients with UGB were consecutively classified according to Child-Pugh criteria and randomized to receive lactulose (group A, n = 63) or no lactulose (group B, n = 65) treatment after the symptoms of active bleeding disappeared. Curative effects were observed for 6 days.
RESULTS
Two patients in group A and 11 in group B had developed HE; the incidence rates were 3.2 and 16.9% (χ(2) 5.2061, p < 0.05). After treatment, a significant increase in ammonia level and higher number connection test (NCT) in the non-lactulose group, median blood ammonia levels (60.0 vs. 52.0), p < 0.05, and median NCT (43 vs. 38), p < 0.05, were observed. Patients who had developed HE had a significantly higher baseline Child-Turcotte-Pugh score (10.15 ±1.82 vs. 6.35 ± 1.60, p < 0.05), alanine aminotransferase (111.25 ± 91.62 vs. 48.32 ± 47.45, p < 0.05), aspartate aminotransferase (171.42 ± 142.68 vs. 46.33 ± 42.68, p < 0.05), total bilirubin (73.44 ± 47.20 vs. 29.75 ± 22.08, p < 0.05), serum albumin (24.65 ± 5.04 vs. 33.43 ± 6.49, p < 0.05), plasma prothrombin time (22.18 ± 4.60 vs. 17.12 ± 4.62, p < 0.05), and lower hemoglobin level (72.31 ± 15.15 vs. 87.45 ± 19.79, p < 0.05) as compared to patients who did not develop HE. On unconditional logistic regression analysis, patients who had developed HE were significantly associated with a higher baseline Child-Turcotte-Pugh score (OR 9.92, 95% CI 1.94-50.63, p < 0.05) and lactulose therapy (OR 0.02, 95% CI 0-0.74, p < 0.05) but were not associated with other parameters.
CONCLUSIONS
Lactulose is an effective prophylaxis agent of HE for cirrhotic patients who had developed UGB.
背景与目的
上消化道出血（UGB）是肝硬化患者发生肝性脑病（HE）的重要诱发因素。本研究旨在评估乳果糖在控制随机试验中对 UGB 后 HE 的预防作用。
方法
根据 Child-Pugh 标准，连续对 128 例 UGB 肝硬化患者进行分类，并随机分为接受乳果糖（A 组，n = 63）或不接受乳果糖（B 组，n = 65）治疗的患者，待出血症状消失后开始治疗。观察 6 天的疗效。
结果
A 组有 2 例患者和 B 组有 11 例患者发生 HE；发病率分别为 3.2%和 16.9%（χ(2) 5.2061，p < 0.05）。治疗后，非乳果糖组血氨水平和更高的数字连接测试（NCT）显著升高，中位数血氨水平（60.0 与 52.0），p < 0.05，中位数 NCT（43 与 38），p < 0.05。发生 HE 的患者的基线 Child-Turcotte-Pugh 评分（10.15 ±1.82 与 6.35 ± 1.60，p < 0.05）、丙氨酸氨基转移酶（111.25 ± 91.62 与 48.32 ± 47.45，p < 0.05）、天冬氨酸氨基转移酶（171.42 ± 142.68 与 46.33 ± 42.68，p < 0.05）、总胆红素（73.44 ± 47.20 与 29.75 ± 22.08，p < 0.05）、血清白蛋白（24.65 ± 5.04 与 33.43 ± 6.49，p < 0.05）、血浆凝血酶原时间（22.18 ± 4.60 与 17.12 ± 4.62，p < 0.05）和血红蛋白水平（72.31 ± 15.15 与 87.45 ± 19.79，p < 0.05）均显著高于未发生 HE 的患者。在非条件逻辑回归分析中，发生 HE 的患者与较高的基线 Child-Turcotte-Pugh 评分（OR 9.92，95%CI 1.94-50.63，p < 0.05）和乳果糖治疗（OR 0.02，95%CI 0-0.74，p < 0.05）显著相关，但与其他参数无关。
结论
乳果糖是肝硬化患者 UGB 后预防 HE 的有效药物。
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