阿卡波糖联合门冬氨酸鸟氨酸对肝硬化患者肝性脑病的疗效评估

Efficacy of Acarbose-linked Ornithine Aspartate in Hepatic Encephalopathy in Cirrhotic Patients

关键词:  阿卡波糖  门冬氨酸鸟氨酸  肝性脑病  疗效  安全性

Key words:  acarbose  ornithine aspartate  hepatic encephalopathy  efficacy  safety

摘要:

目的 评估阿卡波糖联合门冬氨酸鸟氨酸对肝硬化伴肝性脑病患者的疗效及安全性。方法 76例肝硬化伴肝性脑病患者随机分为观察组和对照组（各38例），对照组患者在常规治疗基础上给予门冬氨酸鸟氨酸治疗，观察组患者在常规治疗基础上给予阿卡波糖联合门冬氨酸鸟氨酸治疗。分别于治疗前后，采用全自动生化分析仪测定天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、血清总胆红素（TBIL）和总蛋白（TP）水平等肝功能指标；采用血氨测定仪检测血氨水平；采用显色基质鲎试剂盒与分光光度计测定血浆内毒素水平。采用简易智力状态检查量表（MMSE）、改良长谷川痴呆量表（HDS-R）评估患者的认知能力，采用NCT-A进行神经心理学测试；测定脑代谢产物胆碱（Cho）、肌醇（mI）、谷氨酰胺复合物（Glx）和N-天门冬氨酸（NAA）。观察并记录治疗期间2组患者的不良反应发生情况。结果 治疗后，观察组总有效率显著高于对照组（89.47% vs 71.05%，P<0.05）。观察组AST、ALT、TBIL、血氨和内毒素水平显著低于治疗前和对照组（P<0.05），ALP、TP水平显著高于治疗前和对照组（P<0.05）。观察组MMSE和HDS-R评分均显著高于对照组（P<0.05），NCT时间显著低于对照组（P<0.05）。观察组mI/Cr和Cho/Cr均显著高于治疗前和对照组（P<0.05），Glx/Cr显著低于治疗前和对照组（P<0.05）。结论 阿卡波糖联合门冬氨酸鸟氨酸可以有效降低血氨和内毒素，改善肝性脑病症状，并起到一定的保肝护肝、保护大脑作用，提高患者生活质量。

Abstract:

OBJECTIVE To study the efficacy and safety of acarbose combined with ornithine aspartate in patients with hepatic encephalopathy. METHODS Seventy-six patients with cirrhosis and hepatic encephalopathy were randomly divided into observation group and control group (38 cases in each group). On the basis of routine treatment, patients in the control group were treated with ornithine aspartate, while patients in the observation group were treated with acarbose combined with ornithine aspartate. Before and after treatment, the levels of aspartate aminotransferase (AST), alanine pathological transferase (ALT), alkaline phosphatase (ALP), serum total bilirubin (TBIL) and total protein (TP) levels were measured by automatic biochemical analyzer. The level of blood ammonia was measured with blood ammonia analyzer. The level of plasma endotoxin was determined with chromogenic matrix technetium kit and spectrophotometer. The cognitive status of the patients was evaluated using the Mini-Mental State Examination Scale (MMSE) and the Modified Hasegawa Dementia Scale (HDS-R). Neuropsychological testing was performed using NCT-A. The metabolites levels of the brain was measured, such as choline, alcohol (mI), glutamine complex (Glx) and N-aspartic acid (NAA). Observe and record the occurrence of adverse reactions during the treatment. RESULTS After treatment, the total effective rate of the observation group was significantly higher than the aspartate ornithine alone group (89.47% vs 71.05%, P<0.05). The levels of AST, ALT, TBIL, blood ammonia and endotoxin in the observation group were significantly lower than those before treatment and the control group (P<0.05). ALP and TP levels were significantly higher in the observation group than before treatment and the control group (P<0.05). The MMSE and HDS-R scores in the observation group were significantly higher than those in the control group (P<0.05), and the NCT time was significantly lower than that in the control group (P<0.05). Observed group mI/Cr and Cho/Cr were significantly higher than before treatment and control group (P<0.05), Glx/Cr was significantly lower than that before treatment and control group (P<0.05). CONCLUSION Acarbose combine with ornithine aspartate can effectively reduce blood ammonia and endotoxin, improve the symptoms of hepatic encephalopathy, and play a role in protecting the liver, show the brain protection and the improvement of life quality of patients.