Jain Arpan, Sharma Barjesh Chander, Mahajan Bhawna, Srivastava Siddharth, Kumar Ajay, Sachdeva Sanjeev, Sonika Ujjwal, Dalal Ashok
Department of GastroenterologyGB Pant HospitalNew DelhiIndia.
Department of BiochemistryGB Pant HospitalNew DelhiIndia.
Hepatology. 2022 May;75(5):1194-1203. doi: 10.1002/hep.32255. Epub 2021 Dec 21.
Data on the use of intravenous L-ornithine L-aspartate (LOLA) in the treatment of overt HE (OHE) is limited. We evaluated the role of intravenous LOLA in patients of cirrhosis with OHE grade III-IV.
In a double-blind randomized placebo-controlled trial, 140 patients were randomized to a combination of LOLA, lactulose, and rifaximin (n = 70) or placebo, lactulose, and rifaximin (n = 70). LOLA was given as continuous intravenous infusion at a dose of 30 g over 24 h for 5 days. Ammonia levels, TNF-α, ILs, and endotoxins were measured on days 0 and 5. The primary outcome was the improvement in the grade of HE at day 5. Higher rates of improvement in grade of HE (92.5% vs. 66%, p < 0.001), lower time to recovery (2.70 ± 0.46 vs. 3.00 ± 0.87 days, p = 0.03), and lower 28-day mortality (16.4% vs. 41.8%, p = 0.001) were seen in the LOLA group as compared with placebo. Levels of inflammatory markers were reduced in both groups. Significantly higher reductions in levels of blood ammonia, IL-6, and TNF-α were seen in the LOLA group.
Combination of LOLA with lactulose and rifaximin was more effective than only lactulose and rifaximin in improving grades of HE, recovery time from encephalopathy, with lower 28-day mortality.
关于静脉注射L-鸟氨酸-L-天冬氨酸（LOLA）治疗显性肝性脑病（OHE）的数据有限。我们评估了静脉注射LOLA在III-IV级肝硬化合并OHE患者中的作用。
在一项双盲随机安慰剂对照试验中，140例患者被随机分为接受LOLA、乳果糖和利福昔明联合治疗组（n = 70）或安慰剂、乳果糖和利福昔明组（n = 70）。LOLA以30 g的剂量在24小时内持续静脉输注，共5天。在第0天和第5天测量氨水平、肿瘤坏死因子-α（TNF-α）、白细胞介素（ILs）和内毒素。主要结局是第5天HE分级的改善情况。与安慰剂组相比，LOLA组HE分级改善率更高（92.5%对66%，p < 0.001），恢复时间更短（2.70±0.46天对3.00±0.87天，p = 0.03），28天死亡率更低（16.4%对41.8%，p = 0.001）。两组炎症标志物水平均降低。LOLA组血氨、IL-6和TNF-α水平的降低更为显著。
与仅使用乳果糖和利福昔明相比，LOLA联合乳果糖和利福昔明在改善HE分级、缩短肝性脑病恢复时间以及降低28天死亡率方面更有效。
