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目的评价肝硬化患者Hp感染状况对血氨浓度的影响。方法对46例肝硬化伴高血氨患者的血液以及胃液中氨浓度进行分析,所有患者给予低蛋白饮食、卡那霉素、乳果糖以及丰富的支链氨基酸溶液治疗,其中24例患者仍有高血氨,根据Hp感染分布的状况,把24例患者分成三组:Hp在胃中弥漫性分布的患者为Ⅰ组,Hp在胃中局部分布的患者为Ⅱ组,Hp阴性的患者为Ⅲ组。24例患者均给予口服10 mg雷贝拉唑,1000 mg阿莫西林以及400 mg克拉霉素或500 mg甲硝唑2周进行Hp的根治。结果第Ⅰ组Hp根治后血液以及胃液中血氨浓度明显下降,Hp根治12周后血氨浓度明显降低(P<0.05),第Ⅱ组、Ⅲ组进行Hp根治后血氨浓度未见明显降低。结论胃中Hp弥漫性感染是导致肝硬化患者血氨升高的原因之一,针对Hp弥漫性分布的肝硬化患者,必须进行有效的Hp根治。
Objective To evaluate the effect of Hp infection on serum ammonia concentration in cirrhotic patients. Methods A total of 46 patients with cirrhosis and hyperuricemia were analyzed for blood ammonia concentration and gastric juice. All patients were given low-protein diet, kanamycin, lactulose and rich branched-chain amino acid solution, of which 24 patients still had According to the distribution of Hp infection, 24 patients were divided into three groups: group Ⅰ with diffuse distribution of Hp in stomach, group Ⅱ with local distribution of Hp in stomach, group Ⅲ with Hp negative group. 24 patients were given oral administration of rabeprazole 10 mg, 1000 mg amoxicillin and 400 mg clarithromycin or 500 mg metronidazole for 2 weeks for Hp radical. Results The plasma ammonia concentration in blood and gastric juice was significantly decreased in group Ⅰ after Hp radical treatment. The serum ammonia concentration was significantly decreased after 12 weeks of Hp radical treatment (P <0.05), and no significant decrease in serum ammonia concentration was observed in group Ⅱ and group Ⅲ after Hp radical treatment . Conclusions Diffuse infection of Hp in the stomach is one of the causes of elevated serum ammonia in patients with cirrhosis. For patients with cirrhosis with diffuse distribution of Hp, effective Hp radical therapy is essential.