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

Abstract

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

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.

References

[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.

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

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Shen Yan, Chen Lin. Endoscopic treatment and long-term management of patients with esophagogastric variceal bleeding [J]. Journal of Practical Hepatology, 2023, 26(1): 8-10.
[2]	Zhang Dan, Jiang Jianxin. Comparison of response to recombinant cytokine gene-derived protein or human interferon α-2b and entecavir combination in the treatment of patients with serum HBeAg positive chronic hepatitis B [J]. Journal of Practical Hepatology, 2023, 26(1): 27-30.
[3]	Xu Haibo, Su Huiting, Xiong Yiping, et al. Changes of peripheral blood dNLR, MLR and SII in patients with hepatitis B cirrhosis [J]. Journal of Practical Hepatology, 2023, 26(1): 71-74.
[4]	Chen Ye, Chen Xiaolan, Cao Liling, et al. Cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt [J]. Journal of Practical Hepatology, 2023, 26(1): 79-82.
[5]	Liu Nannan, Li Wei, Zhao Shousong. Diagnostic performance of simplified animal nomenclature test in predicting minimal hepatic encephalopathy in patients with liver cirrhosis [J]. Journal of Practical Hepatology, 2023, 26(1): 83-86.
[6]	Dai Huan, Li Kai, Zhu Yongxiang, et al. Efficacy of endoscopic ligation and tissue glue injection in the treatment of patients with hepatitis B liver cirrhosis and esophageal and gastric varices bleeding [J]. Journal of Practical Hepatology, 2023, 26(1): 87-90.
[7]	Xu Qing, Yang Jian, Zong Jinjuan. Imaging and histopathological features in patients with idiopathic non-cirrhotic portal hypertension [J]. Journal of Practical Hepatology, 2023, 26(1): 91-94.
[8]	Ding Haibin, Zhang Xin, Li Ya, et al. TACE with sequential microwave ablation followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2023, 26(1): 108-111.
[9]	Peng Yu, Li Haitao, Yang Wenli, et al. Clinical efficacy of PD-1 inhibitor and lenvatinib in the treatment of elderly patients with advanced primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 112-115.
[10]	Du Shangyun, Weng Li, Wu Min. Clinical observation of camrelizumab therapy after TACE in the treatment of patients with advanced primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 116-119.
[11]	Dong Xianjin, Su Wei, Li Liansheng, et al. Comparison of laparoscopic hepatectomy and open hepatectomy in the treatment of patients with intrahepatic cholangiocarcinoma [J]. Journal of Practical Hepatology, 2023, 26(1): 120-123.
[12]	Yin Qiushi, Wang Xueguo, Song Qifeng. Clinical efficacy of laparoscopic hepatectomy in the treatment of patients with intrahepatic bile duct stones [J]. Journal of Practical Hepatology, 2023, 26(1): 124-127.
[13]	Zhang Fu, Chen Junmao, Liang Xiaohui. Efficacy of primary suture laparoscopic common bile duct exploration in the treatment of patients with choledocholithiasis [J]. Journal of Practical Hepatology, 2023, 26(1): 128-131.
[14]	Liu Songhang, Gao Youkui, Cao Liangqi. Clinical efficacy of LC and ERCP in the treatment of patients with gallbladder and extrahepatic bile duct stones [J]. Journal of Practical Hepatology, 2023, 26(1): 132-135.
[15]	Zhang Zixia, Li Delin, Zhang Guoliang. Clinical efficacy of Yipi Yanggan Decoction after radiofrequency ablation in the treatment of patients with primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 142-144.