门冬氨酸鸟氨酸联合结肠透析治疗肝性脑病患者疗效及其对血浆β-EP和LPS的影响*

doi:10.3969/j.issn.1672-5069.2023.01.020

摘要/Abstract

摘要： 目的观察应用门冬氨酸鸟氨酸联合结肠透析治疗肝性脑病(HE)患者的疗效及其对血浆β-内啡肽(β-EP)和内毒素(LPS)的影响。方法 2019年1月～2021年12月我院收治的肝硬化并发HE患者123例,采用随机数字表法分为观察组62例和对照组61例。在内科治疗的基础上,给予对照组结肠透析治疗,给予观察组门冬氨酸鸟氨酸联合结肠透析治疗,两组均治疗观察7～10天。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、IL-6及血浆β-EP和LPS水平,常规检测血氨。应用简易智力状态检查量表(MMSE)和数字连接试验(NCT)评价认知功能。结果在治疗后,观察组病死率为16.1%,显著低于对照组的36.1%(P＜0.05);治疗后,观察组总胆红素(TBIL)水平为(41.6±8.2)μmol/L,显著低于对照组【(50.8±9.4)μmol/L,P＜0.05】,血氨水平为(60.8±6.3)μmol/L,显著低于对照组【(82.4±9.6)μmol/L,P＜0.05】;观察组血清TNF-α、IL-8、IL-6、β-EP和LPS水平分别为(27.5±5.3)ng/L、(44.9±7.2)ng/L、(50.6±8.4)ng/L、(38.6±3.8)pg/mL和(17.5±3.1)pg/mL,均显著低于对照组【分别为(39.7±6.8)ng/L、(62.8±9.3)ng/L、(74.8±11.5)ng/L、(50.7±4.9)pg/mL和(24.8±3.6)pg/mL,P＜0.05】;观察组MMSE评分为(27.4±3.8)分,显著高于对照组【(23.9±3.6)分,P＜0.05】,而NCT用时为(50.3±4.8) s,显著短于对照组【(60.5±5.9)s,P＜0.05】。结论应用门冬氨酸鸟氨酸联合结肠透析治疗HE患者可提高疗效和短期生存率,可能与降低了血氨,缓解了机体炎症反应,降低血浆β-EP水平有关。

关键词: 肝硬化, 肝性脑病, 门冬氨酸鸟氨酸, 结肠透析, β-内啡肽, 内毒素, 治疗

Abstract: Objective The aim of this study was to observe the short-term efficacy of ornithine aspartate at base of colon dialysis in treatment of patients with hepatic encephalopathy (HE). Methods 123 patients with liver cirrhosis and complicated HE were encountered in our hospital between January 2019 and December 2021, and were randomly divided into control (n=61)and observation group (n=62), receiving colon dialysis or colon dialysis and intravenous ornithine aspartate administration at base of conventional supporting treatment for 7 to 10 days. Serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), IL-6, plasma β-endorphin (β-EP) and endotoxin (LPS) were detected by ELISA. The blood ammonia was routinely detected. The cognitive function was assessed by mini-mental state examination (MMSE) and by number connection test (NCT). Results At the end of the treatment, the mortality rate in the observation group was significantly lower than that in the control group (16.1% vs. 36.1%, P<0.05); the total serum bilirubin level in the observation group was (41.6±8.2) μmol/L, significantly lower than [(50.8±9.4) μmol/L, P<0.05] in control group, and blood ammonia level was (60.8±6.3) μmol/L, significantly lower than [(82.4±9.6) μmol/L, P<0.05] in the control group; serum TNF-α, IL-8, IL-6, β-EP and LPS levels in the observation group were (27.5±5.3)ng/L, (44.9±7.2)ng/L, (50.6±8.4)ng/L, (38.6±3.8)pg/mL and (17.5±3.1)pg/mL, all significantly lower than [(39.7±6.8) ng/L, (62.8±9.3)ng/L, (74.8±11.5)ng/L, (50.7±4.9)pg/mL and (24.8±3.6)pg/mL, respectively, P＜0.05] in the control; the MMSE score was (27.4±3.8), much higher than [(23.9±3.6), P＜0.05], while the time of NCT was (50.3±4.8) s, much quicker than [(60.5±5.9)s, P＜0.05] in the control group. Conclusion The intravenous infusion of ornithine aspartate at base of colon dialysis in the treatment of patients with HE could improve the short-term survival, which might be related to the reduction of blood ammonia andβ-EP levels as well as the inhibition of inflammatory reaction.

Key words: Liver cirrhosis, Hepatic encephalopathy, Ornithine aspartate, Colon dialysis, β-endorphin, Endotoxin, Therapy

李苏苏, 董媛, 贾浩延, 秦颖. 门冬氨酸鸟氨酸联合结肠透析治疗肝性脑病患者疗效及其对血浆β-EP和LPS的影响^*[J]. 实用肝脏病杂志, 2023, 26(1): 75-78.

Li Susu, Dong Yuan, Jia Haoyan, et al. Observation of ornithine aspartate at base of colon dialysis in treatment of patients with hepatic encephalopathy[J]. Journal of Practical Hepatology, 2023, 26(1): 75-78.

参考文献

[1] Gil-Gómez A, Ampuero J, Rojas Á, et al. Development andvalidation of a clinical-genetic risk score to predict hepatic encephalopathy in patients with liver cirrhosis. Am J Gastroenterol, 2021, 116(6):1238-1247.
[2] Tapper EB, Aberasturi D, Zhao Z, et al. Outcomes after hepatic encephalopathy in population-based cohorts of patients with cirrhosis. Aliment Pharmacol Ther, 2020, 51(12):1397-1405.
[3] Butterworth RF. Ammoniaremoval by metabolic scavengers for the prevention and treatment of hepatic encephalopathy in cirrhosis. Drugs R D, 2021, 21(2):123-132.
[4] Canbay A, Sowa JP. L-ornithine l-aspartate (lola) as a novel approach for therapy of non-alcoholic fatty liver disease. Drugs, 2019, 79(Suppl 1):39-44.
[5] Butterworth RF. Beneficial effects ofl-ornithine l-aspartate for prevention of overt hepatic encephalopathy in patients with cirrhosis: a systematic review with meta-analysis. Metab Brain Dis, 2020, 35(1):75-81.
[6] Dahaba AA. Possible explanations for the odd phenomenon of liver-assist albumen-dialysis hepatic encephalopathy stepwise "plateau" electroencephalography recovery. Minerva Anestesiol, 2018, 84(2):262-264.
[7] 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南. 实用肝脏病杂志, 2018, 21(6):999-1014.
[8] Machado Junior PAB, Ziliotto RD, Ferreira APVN, et al. Use of the stroop encephalapp for covert hepatic encephalopathy screening in cirrhotic patients in southern brazil. Arq Gastroenterol, 2020, 57(4):399-403.
[9] Strober L, DeLuca J, Benedict RH, et al. Symboldigit modalities test: a valid clinical trial endpoint for measuring cognition in multiple sclerosis. Mult Scler, 2019, 25(13):1781-1790.
[10] Rahimi RS, Brown KA, Flamm SL, et al. Overthepatic encephalopathy: current pharmacologic treatments and improving clinical outcomes. Am J Med, 2021, 134(11):1330-1338.
[11] Rose CF, Jalan R, Shawcross DL. Erroneousammonia measurement is not synonymous with a lack of efficacy of ammonia-lowering therapies in hepatic encephalopathy. Clin Gastroenterol Hepatol, 2021, 19(11):2456-2457.
[12] Tapper EB. Atrial of ornithine phenylacetate and the arc of ammonia's history in the management of overt hepatic encephalopathy. Clin Gastroenterol Hepatol, 2021, 19(12):2493-2495.
[13] Kircheis G, Lüth S. Pharmacokinetic andpharmacodynamic properties of l-ornithine l-aspartate (lola) in hepatic encephalopathy. Drugs, 2019, 79(Suppl 1):23-29.
[14] Li Y, Dai M, Yan J, et al. Colonic dialysis can influence gut flora to protect renal function in patients with pre-dialysis chronic kidney disease. Sci Rep, 2021, 11(1):12773.
[15] Rubio T, Felipo V, Tarazona S, et al. Multi-omic analysis unveils biological pathways in peripheral immune system associated to minimal hepatic encephalopathy appearance in cirrhotic patients. Sci Rep, 2021, 11(1):1907.
[16] Zhuge W, Zhuge Q, Wang W, et al. Hydrogen sulphide ameliorates dopamine-induced astrocytic inflammation and neurodegeneration in minimal hepatic encephalopathy. J Cell Mol Med, 2020, 24(23):13634-13647.
[17] Pilozzi A, Carro C, Huang X. Roles of β-endorphin in stress, behavior, neuroinflammation, and brain energy metabolism. Int J Mol Sci, 2020, 22(1):338.
[18] 王军, 张流, 熊华刚, 等. 醒脑静联合纳洛酮治疗肝性脑病患者认知和血清炎症因子水平变化. 实用肝脏病杂志, 2018, 21(3):471-472.
[19] Solé C, Guilly S, Da Silva K, et al. Alterations ingut microbiome in cirrhosis as assessed by quantitative metagenomics: relationship with acute-on-chronic liver failure and prognosis. Gastroenterology, 2021, 160(1):206-218.
[20] Juanola O, Ferrusquía-Acosta J, García-Villalba R, et al. Circulating levels of butyrate are inversely related to portal hypertension, endotoxemia, and systemic inflammation in patients with cirrhosis. FASEB J, 2019, 33(10):11595-11605.

门冬氨酸鸟氨酸联合结肠透析治疗肝性脑病患者疗效及其对血浆β-EP和LPS的影响^*

Observation of ornithine aspartate at base of colon dialysis in treatment of patients with hepatic encephalopathy

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