| Objective:The clinical manifestations of patients with minimal hepatic encephalopathy in liver cirrhosis are not obvious,the detection rate and intervention rate are low,and the quality of daily life and prognosis of patients are significantly reduced.Therefore,it is of great significance for the early diagnosis and treatment of the disease.The purpose of this study was to analyze the clinical efficacy of different treatment schemes in patients with liver cirrhosis and minimal hepatic encephalopathy.Methods:Patients with liver cirrhosis and minimal hepatic encephalopathy diagnosed in the Department of hepatobiliary and pancreatic medicine of our hospital from November 2020 to September 2021 were selected.A total of 68 patients were included according to the inclusion criteria and exclusion criteria.All patients were randomly divided into three groups: lactulose plus nutrition group,lactulose plus probiotics group and lactulose group.Among them,23 patients in lactulose plus nutrition group,23 patients in lactulose plus probiotics group and 22 patients in lactulose group.Lactulose group was given oral lactulose（Duphalac,Abbott Healthcare Products B.VSpecification: 15ml/ bag）,once a day,1 bag each time,for12 weeks;Lactulose plus probiotics group was additionally given bifidobacterium quadruple viable tablets（Siliankang,Hangzhou Yuanda Biological Pharmaceutical Co.,LTD.,Specification: 0.5g/ tablet）,3 tablets each time,3 times a day,for consecutive 12 weeks;The lactulose plus nutrition group was given nutritional treatment on top of lactulose,and relevant health education was carried out for patients and their families,so that patients ate strictly in accordance with dietary principles and protein intake,and maintained for 12 weeks.ALB,Child-pugh score,Child-pugh classification,MELD,NCT-A,DST,TSF and AMC of all enrolled patients before treatment and at 4,8 and 12 weeks of treatment were recorded respectively,and the changes of indexes at each stage under different treatment methods were analyzed and compared.Results:1.ALB improvement before and after treatmentIntra-group comparison: patients in lactulose plus nutrition group,in 4 weeks,8weeks,12 weeks after treatment,the ALB than before experiment were higher（P<0.05）.Lactulose and probiotics group,lactulose group,at different time points of treatment,there was no significant difference compared with that before treatment.Comparison between groups: there was no significant difference among the three groups after 4 weeks of treatment;After 8 and 12 weeks of treatment,lactulose plus nutrition group was significantly higher than lactulose group and lactulose plus probiotics group（P<0.001）.2.Child-pugh score and Child-pugh classification before and after treatment（1）Child-Pugh score:Intra-group comparison: at 4,8 and 12 weeks of treatment,the child-pugh score of the three groups decreased in varying degrees compared with that before treatment（P<0.05）.Comparison between groups: after 8 weeks of treatment,the score of lactulose plus nutrition group was significantly lower than that of lactulose group（P<0.05）;After 12 weeks of treatment,the score of lactulose plus nutrition group was significantly lower than that of lactulose group and lactulose plus probiotics group（P<0.001,P<0.05）.（2）Child-pugh grading:Intra-group comparison: compared with before treatment,the number of children whose child-Pugh grade improved to grade A in lactulose plus nutrition group increased significantly after 8 and 12 weeks of treatment（P<0.05）;After 12 weeks of treatment,the number of child-Pugh grade A in lactulose plus probiotics group also increased significantly（P<0.05）.Comparison between groups: after 8 weeks of treatment,the grade improvement of lactulose plus nutrition group was better than that of lactulose group（P<0.05）;After 12 weeks of treatment,the grade improvement of lactulose plus nutrition group was significantly better than that of lactulose group and lactulose plus probiotics group（P<0.05）,and the grade improvement of lactulose plus probiotics group was better than that of lactulose group（P<0.05）.3.Comparison of MELD scores before and after treatmentIntra-group comparison: The MELD scores of the three groups were significantly lower than those before treatment（P<0.05）.Comparison between groups: after 4 and 8 weeks of treatment,MELD scores in lactulose plus nutrition group and lactulose plus probiotics group were lower than those in lactulose group（P<0.05）;After 12 weeks of treatment,MELD scores in lactulose plus nutrition group and lactulose plus probiotics group were lower than those in lactulose group（P<0.001,P<0.05）.4.Comparison of NCT-A and DST before and after treatment（1）NCT-AIntra-group comparison: NCT-A in three groups was lower than before treatment（P<0.05）.Comparison between groups: there was no significant difference between the groups after 4 and 8 weeks of treatment;After 12 weeks of treatment,the lactulose plus nutrition group was significantly lower than that of lactulose group and lactulose plus probiotics group（P<0.05）.（2）DSTIntra-group comparison: DST in 3 groups was higher than before treatment（P<0.05）.Comparison between groups: after 8 weeks of treatment,the DST score of lactulose plus nutrition group was significantly higher than that of lactulose group and lactulose plus probiotics group（P<0.05）;After 12 weeks of treatment,DST in lactulose plus nutrition group was significantly higher than that in lactulose group and lactulose plus probiotics（P<0.001）.5.Comparison of TSF and AMC before and after treatment（1）TSFIntra-group comparison: compared with that before treatment,TSF in lactulose plus nutrition group was significantly higher at 4,8 and 12 weeks than that before treatment（P<0.05）,and there was no significant change in TSF at different treatment time points in lactulose group and lactulose plus probiotics group.Comparison between groups: after 8 weeks of treatment,TSF in lactulose plus nutrition group was significantly higher than that in lactulose group and lactulose plus probiotics group（P<0.05）;After 12 weeks of treatment,lactulose plus nutrition group was significantly higher than lactulose group and lactulose plus probiotics group（P<0.001）.（2）AMCIntra-group comparison:compared with that before treatment,AMC in lactulose plus nutrition group was significantly higher at 4,8 and 12 weeks than that before treatment（P<0.05）,and there was no significant change in AMC at different treatment time points in lactulose group and lactulose plus probiotics group.Comparison between groups: after 4 and 8 weeks of treatment,lactulose plus nutrition group was significantly higher than lactulose group and lactulose plus probiotics group（P<0.05）;After 12 weeks of treatment,lactulose plus nutrition group was significantly higher than lactulose group and lactulose plus probiotics group（P<0.001）.Conclusion:1.Compared with the lactulose probiotics group and lactulose group,ALB of patients in the lactulose nutrition group increased significantly after treatment.2.With the progress of treatment,child-Pugh score and classification of patients in the lactulose nutrition group were significantly better than those in the lactulose group and the lactulose probiotics group.3.Compared with the lactulose group,the lactulose nutrition group and the lactulose probiotics group could significantly reduce MELD score.4.With the progress of treatment,lactulose nutrition group was significantly better than lactulose probiotics group and lactulose group in improving the psychological score of hepatic encephalopathy.5.Nutritional therapy can significantly increase TSF and AMC,and improve the nutritional status of patients with cirrhosis. |
PDF Full Text Request