Study On The Risk Factors Of Minimal Hepatic Encephalopathy And The Therapeutic Effect Of Lactulose Combined With Probiotics

Background and aims:The occurrence of Minimal Hepatic Encephalopathy(MHE)is related to the progress of hepatic cirrhosis,it may be a sign of disease progression.Evaluation of whether or not MHE is helpful in judging prognosis and prognosis of patients.This paper aims to explore the incidence of MHE in patients with hepatic cirrhosis;to analysis the risk factors of minimal hepatic encephalopathy,and to observe the therapeutic effect of Lactulose combined with probiotics on minimal hepatic encephalopathy.Methods:1.127 cases of consecutive cirrhotic patients aged 18~64 years old were selected,all of them underwent the Number Connection Test A(NCT-A)and Digital Symbol Test(DST).MHE was diagnosed if two test results were both positive at the same time.We recorded each patient’s gender,age,etiology,alcohol or not and the serum endotoxin,blood ammonia,hemoglobin,liver function,abdominal ultrasound,CT or MRI et al,then we analyze the risk factors of MHE.2.These MHE patients were divided into two groups with a ratio of 1:1.Two groups were both given standard treatment for cirrhosis,including reasonable relaxation,temperance,an appropriate diet,application of liver-protecting agents,antiviral therapy and et al.One group was given lactulose combined with probiotics treatment on the basis of standard treatment for cirrhosis at the same time.The time of therapy was about 7 days.The changes of DST,NCT-A,serum endotoxin and blood ammonia between the two groups were compared to assess the therapeutic effect of Lactulose combined with probiotics in consecutive cirrhotic patients complicated with MHE.Results:1.Among the 127 cases of hepatic cirrhosis enrolled in this study,62 patients had positive results of NCT-A and DST,and the incidence rate of MHE was 48.8%.The statistical analysis showed that blood ammonia,endotoxin,Child-pugh classification,ascites had significant differences between the two groups(P<0.05),but age,education,gender,alcohol or not,hemoglobin,prothrombin time,alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,serum sodium,and serum potassium levels were not related to the occurrence of MHE(P>0.05).By multivariate logistic regression analysis of Child-pugh classification,ascites,blood ammonia and endotoxin,it showed that blood ammonia and serum endotoxin were the independent risk factors of MHE(P<0.05).2.After 7 days of treatment,the results of NCT-A and DST were improved,simultaneously serum endotoxin and blood ammonia level lowered between the two groups compared with before treatment.Lactulose combined with probiotics treatment group was better than the standard treatment group,the difference was statistically significant(P<0.05).Conclusions:1.The elevated levels of blood ammonia and serum endotoxin are risk factors for consecutive cirrhotic patients complicated with MHE,while ascites and Child-Pugh classification are correlated with MHE in a certain extent.2.The treatment of Lactulose combined with probiotics can lower the level of blood ammonia and endotoxin,and it contributes to the improvement of NCT-A and DST results in these cirrhotic patients complicated with MHE,so lactulose combined with probiotics is effective for MHE.