The Influence Of Helicobacter Pylori Infection And Other Factors On Blood Ammonia Concentration In Patients With Hepatic Cirrhosis

Objective: To study the influence of Helicobacter pylori (Hp) infection and other factors on blood ammonia concentration in patients with cirrhosis by according to the change of blood ammonia concentration before and after Hp eradication therapy. Methods : Thirty two patients with hepatic cirrhosis from our hospital in 2004 were observed. All patients were detected for Hp by rapid urease test and C14 –urea breath test. Hp infection was determined by Positive result detected both methods. All patients did not use antibiotic within one month and their Blood Urea Nitrogene and Creatinine was normal before entering hospital. Each was examined with gastroscopy, Hepatic function,B-ultrasonic test of portal vein and etc. before their therapy. Twelve patients without Hp infecton were study as group A, twenty patients with Hp infection were divided into group B (9 cases) and group C (11 cases). All patients were treated with low protein diet, lactulose, branched chain enriched amino acid, Potassium Magnesium Aspartate and reduced glutathione for a week. Hp was eradicated simultaneously for patients of group C. Fasting blood ammonia levels were measured before and after treatment. The therapy project about protecting liver function: The 1.2g Reduced Glutathione and 30ml Pannagin were injected one time a day, aggregately 7 days. The regular project for reduced ammonia: Duphalac was taken orally for three times a day; low protein diet was gaven; 200ml branched-chain Amino Acid was injected for one time a day, aggregately 7 days. The project for Hp eradication (the standard project): PPI +Amoxicillin+ Clarithromycin, 7 days. Results: ⑴The rate of Hp infection was 62.5% in 32 patients with hepatic cirrhosis. ⑵There was no difference significantly for fasting blood ammonia between positive and negative group befor treatment(p>0.05). ⑶And different Child-pugh stage of liver function had obviously positive correlation with blood ammonia levels befor treatment(rs=0.854,p<0.01) . ⑷Furthermore, the degree of esophageal varices had positive correlation with blood ammonia levels befor treatment (rs=0.408, p<0.05). ⑸The width of portal vein had no correlation with blood ammonia levels befor treatment (r=-0.084, p>0.05). ⑹Comparing with fasting ammonia concentration of three groups after treatment, no significant difference was found (F=1.511,p=0.238). ⑺Ammonia levels was remarkably decreased in three groups after treatment (p<0.01).⑻The reduction ratio was obtained by the value of reduction after treatment / level of ammonia before treatment,in which no significant difference was found among group A, B and C (p>0.05). ⑼Level of ammonia before treatment, after treatment, reduction value and ratio of ammonia were observed in A.B.C degree of group c and Rank sum test was used to compare them. There is only significance of level of ammonia before treatment among three degree (p<0.05). Conclusions : 1. There is no difference on the blood ammonia concentration between Hp positive and Hp negative patients with hepatic cirrhosis befor and after treatment of protecting hepatic cells. 2. Level of ammonia is correlated with degree of Child-pugh and esophageal varicose, however it is not correlated with width of portal vein. 3. No difference was observed for the reduction ratio of ammonia after treatment between groups of Hp positive and negative patients with hepatic cirrhosis. Hp eradication therapy did not reduce level of ammonia, indicating Hp infection may be not associated markedly with high level of blood ammonia.