Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Aliment Pharmacol Ther. 2014 Jul;40(1):63-71. doi: 10.1111/apt.12795. Epub 2014 May 15.
Use of TIPSS is associated with increases in ammonia concentration and hepatic encephalopathy (HE) risk. L-ornithine-L-aspartate (LOLA) is effective in reducing ammonia concentration.
To evaluate the effects of LOLA on venous ammonia concentration after TIPSS.
The included patients were randomised to receive LOLA or no-LOLA treatment for 7 days. Fasting and post-prandial venous ammonia levels were the primary outcomes. Psychometric performance, post-TIPSS HE, and liver and renal function were assessed as secondary outcomes.
Of 133 cirrhotic patients who received successful TIPSS between November 2011 and June 2012, 40 met the inclusion criteria and were randomised to the LOLA (n = 21) or control (n = 19) groups. Change in fasting ammonia significantly favoured the LOLA group at days 4 (P = 0.001) and 7 (P = 0.003). Changes in post-prandial ammonia concentration significantly favoured the LOLA group at days 1, 4 and 7 as well. During the study period, patients in the LOLA group had better improvement in psychometric tests than those in the control group. Overt HE during treatment was observed in one patient in the LOLA group and three patients in the control group (P = 0.331). There were no differences in complications, adverse events or mortality between the two groups.
Prophylactic use of LOLA infusion after TIPSS is safe and effective in significantly reducing the increase of venous ammonia concentration, and can benefit the patient's mental status as well.
经颈静脉肝内门体分流术（TIPSS）会导致血氨浓度升高和肝性脑病（HE）风险增加。L-鸟氨酸-L-天冬氨酸（LOLA）可有效降低血氨浓度。
评估 LOLA 对 TIPSS 后静脉血氨浓度的影响。
纳入的患者被随机分为 LOLA 治疗组或非 LOLA 治疗组，疗程为 7 天。空腹和餐后静脉血氨水平是主要结局。心理测量表现、TIPSS 后 HE 以及肝肾功能是次要结局。
2011 年 11 月至 2012 年 6 月期间，133 例接受成功 TIPSS 的肝硬化患者中，有 40 例符合纳入标准并被随机分为 LOLA 组（n = 21）或对照组（n = 19）。第 4 天（P = 0.001）和第 7 天（P = 0.003），LOLA 组空腹血氨的变化更有利于 LOLA 组。第 1、4 和 7 天，餐后血氨浓度的变化也更有利于 LOLA 组。在研究期间，LOLA 组患者的心理测试改善情况优于对照组。LOLA 组有 1 例患者和对照组有 3 例患者在治疗期间出现显性 HE（P = 0.331）。两组之间在并发症、不良事件或死亡率方面无差异。
TIPSS 后预防性 LOLA 输注安全有效，可显著降低静脉血氨浓度升高，改善患者的精神状态。
