The Effective Of Lactulose Or Nucleosides And Nucleoside Analogues Antiviral Therapy In The Treatment Of Minimal Hepatic Encephalopathy

Objective:Discussion the effective of lactulose in the treatment of Minimal hepaticencephalopathy（MHE）,find out whether laclulose therapy may improve the liverfunction、 ruduce Child-pugh score and Arterial ammonia in patients with MHE.Methods:Investigation from July2012to January2013mean age43.510.8years old andin frequency343cases of patients with live cirrhosis patients in the China-Japanunion hospital affiliated hospital of jilin university，Analysis the etiology and theChild-pugh classification。 Given all of cirrhosis patient psychometric hepaticencephalopathy test,including number connection test A、B、C and digit symbol test，MHE was diagnosed by all abnormal number connection test and digit symbol test，158of343patients were diagnosed with MHE.158patients were randomized tolactulose15-50ml/third perday for8weeks(lactulose group) and control group, theArterial ammonia、the function of liver、 Child-pugh classification assessment andPHES test was done an baseline and at8weeks.Results:Analysis the pathogeny of343patients with cirrhosis,the proportion of HBVinfection leads to cirrhosis was highest （56.7%）,followed by alcoholiccirrhosis(20.5%).158of343(46.1%) patients with cirrhosis had MHE. Theprevalence of different pathogeny cirrhosis respectively were：HBV35.1%、HCV48.1%、Alcoholic cirrhosis68.6%、others63.0%, the prenalence of cirrhosis withdifferent pathogeny had significant difference.The prenalence of different Child-pughclassification respectively were： Child A29.5%、 Child B49.7%、 Child C66.7%m,the prenalence of Child A、B and C had significant difference. After8weeks,MHE recovered in lactulose group was45.3%%,MHE improvedsignificantly in lactulose group compared with control group。Compared the recoveryrate of MHE with different pathogeny cirrhosis, the patients of HBV viral hepaticcirrhosis had significant effect. There was no significant change in the liver functionand Child-pugh classfication after therapy8weeks in laculose group and the controlgroup，but arterial ammonia level in lactulose groupwere significantly more thancontrol group.HE was observed during the follow-up period in12MHE patients(2cases belong to lactulose group,10cases belong to control group)，there were2patients dead（2cases belonged to control group：1patients dead due to uppergastronitestinal bleeding；1patients dead because of HE.）.In lactulose group there wasno apparent side effects，there were：diarrhea in3，abdominal pain in1，but allofpatients completion of the study.Conclusion：A total of46.1%of the patients with ciffhosis had MHE,the prevelence of MHEwas highest in alcoholic cirrhosis patients.Child-pugh classification is an importantrisk factors.lactulose are effective in the treatment of MHE in short time(8weeks),especially in cirrhosis patients with HBV. The liver function and Child-pughclassfication was yet unclear after therapy8weeks with lactulose. Objective:Discussion the effective of nucleosides and nucleoside analogues antiviraltherapy of minimal hepatic encephalopathy（MHE）,and compared with laclulosecombination nucleosides and nucleoside analogues antiviral therapy,the nucleosidesand nucleoside analogues antiviral therapy alone can improve the recovery rate ofMHE in cirrhosis patients with HBV.Methods:Investigation from July2010to July2012mean age47.515.3years old and infrequency287cases of patients with live cirrhosis patients because of HBV in theChina-Japan union hospital affiliated hospital of jilin university，Analysis the etiologyand the Child-pugh classification。Given all of cirrhosis patient psychometric hepaticencephalopathy test,including number connection test A、B、C and digit symbol test，105of287patients were diagnosed with MHE.105patients were randomized tolactulose15-50ml/third perday for8weeks(L group) and no lactulose group(NLgroup). the Arterial ammonia assessment and PHES test was done at baseline、8weeks and6months. along the6months,the patients in no lactulose group test thePHES,find out the trend of the PHES score.Results:After8weeks,MHE recovered in lactulose group was47.1%%,MHE improvedsignificantly in lactulose group compared with no lactulose group。Following the6months, the recovery rate of lactulose group and no lactulose group was respectively39.7%and33.3%,There was no significant change between the two group.butcompared with before treatment had significant difference.the trend of PHESdecreased,compared with before treatment,at6months the score of PHES hadsignificant difference.The arterial ammonia level in lactulose groupwere significantly more than nolactulose group at8weekw and6months,and got the same results compared withbefore treatment.but in lactulose group the ammonia level at8weeks and6monthshad no significant difference. HE was observed during the follow-up period in10MHE patients(4cases belongto lactulose group,6cases belong to no lactulose group)，there were8patients dead（3cases belonged to lactulose group：2patients dead due to upper gastronitestinalbleeding；1patients dead because of HE;5cases belonged to lactulose group：3patients dead due to upper gastronitestinal bleeding；1patients dead because of HEand1patient dead due to spontaneous bacterial peritonitis）.Conclusion：.treatmented with nucleosides and nucleoside analogues antiviral therapy （＞6months）are effective in MHE of cirrhosis patients with HBV.and the MHE incirrhosis with HBV who were offered to nucleosides and nucleoside analoguesantiviral therapy,gived the lactulose at the same time,can reduce the level of ammoniaand improve the rate of MHE recovery.