背景:目前肝性脑病发病机制未完全清楚,可能以氨中毒学说最确实有据,乳果糖的降氨作用机制比较清楚,国内外关于乳果糖治疗肝性脑病的研究很多,但尚缺乏关于乳果糖长短程治疗与安慰剂对照治疗的比较研究。目的:采用乳果糖对轻微型肝性脑病患者进行长/短程治疗,并比较其对轻微型肝性脑病患者生活质量的影响。设计:病例-对照观察。单位:广州市第一人民医院老年病科。对象:于1998-06/2002-03在广州市第一人民医院老年病科就诊的连续的肝硬化患者中随机选择经数字连接试验,数字符号试验和/或诱发电位检查异常并配合治疗的轻微型肝性脑病患者60例,随机分为对照组、乳果糖短程组及长程组,每组20例。方法:对照组仅给予复合维生素B,2片/次,3次/d,治疗24周实验结束;乳果糖短程治疗组在此基础上再给予口服乳果糖15～90mL/d,治疗8周,长程组则给予口服乳果糖至24周。分别在第0,8,16,24周末进行生活质量(中国版)调查,并观察肝性脑病发生率。同时进行血氨浓度的实验室检测。主要观察指标:治疗过程中患者生活质量和血氨浓度的变化。结果:在治疗过程中,对照组1例失去联系,短程组1例交通意外死亡,长程组2例不能耐受腹泻的副作用退出。共56例完成治疗进入结果分析。①对照组、短程治疗组、长程治疗组6个月累积肝性脑病发生率分别为40%(8/20),30%(6/20),5%(1/20)。长程治疗组发生率均低于对照组及短程组,差异有显著性意义(P<0.05),但短程组与对照组差异无显著性意义(P>0.05)。②治疗后8,12,24周对照组、乳果糖短程组及长程组组间生活质量的环境领域评分差异无显著性意义(P>0.05),但在生活质量的生理、心理、社会关系领域差异均有显著性意义(P<0.05):其中第8周时乳果糖长程组、短程组均较对照组有明显改善,长短程组之间差异不显著;第16周时乳果糖长程组均较短程组和对照组有明显改善,短程组和对照组之间差异不显著;第24周时乳果糖长程组均明显好于对照组和短程组。③治疗后16,24周乳果糖长程组血氨与对照组、乳果糖短程组比较显著降低,差异有显著性意义。结论:乳果糖长程维持治疗能提高轻微型肝性脑病患者的生活质量,降低肝性脑病的发生率,降低血氨浓度;短程治疗改善生活质量的效果不明显。 BACKGROUND: At present, the pathogenesis of hepatic encephalopathy is not fully understood. It may be the most accurate theory of ammonia poisoning. The mechanism of reducing ammonia by lactulose is relatively clear. There are many researches on lactulose treatment of hepatic encephalopathy both at home and abroad, Comparative Study of Fructose Long - short - course and Placebo - controlled Treatment. OBJECTIVE: To investigate the effect of lactulose on long / short course of patients with mild hepatic encephalopathy and to compare their effects on quality of life in patients with mild hepatic encephalopathy. Design: Case-control observation. Unit: Guangzhou First People’s Hospital Geriatrics. PARTICIPANTS: A randomized trial of digital connection test, digital sign test and / or evoked potential anomalies was performed in patients with concomitant cirrhosis treated in Guangzhou Geriatric Department of the First People’s Hospital from June 1998 to March 2002 with mild treatment 60 patients with hepatic encephalopathy were randomly divided into control group, lactulose short-term group and long-term group, 20 cases in each group. Methods: The control group was given only vitamin B complex, 2 tablets / time, 3 times / d, the end of treatment for 24 weeks; lactulose short-term treatment group was given oral lactulose 15 ~ 90mL / d for 8 weeks, Long-term group was given oral lactulose to 24 weeks. Quality of life (China version) at the 0,8,16,24 weekend were investigated and the incidence of hepatic encephalopathy was observed. At the same time, blood ammonia concentration laboratory tests. MAIN OUTCOME MEASURES: Changes in patient quality of life and serum ammonia concentration during treatment. Results: In the course of treatment, one case of the control group lost contact, one case died of traffic accidents in the short-term group, and two cases of long-term group were unable to tolerate the side effects of diarrhea. A total of 56 patients completed the treatment into the result analysis. ① The incidence of cumulative hepatic encephalopathy in control group, short-term treatment group and long-term treatment group were 40% (8/20), 30% (6/20) and 5% (1/20) respectively at 6 months. The incidence of long-term treatment group were lower than the control group and short-term group, the difference was statistically significant (P <0.05), but there was no significant difference between the short-term group and the control group (P> 0.05). ② There was no significant difference in the quality of life between the control group, lactulose short-term group and long-term group at 8, 12, 24 weeks after treatment (P> 0.05), but in the field of physical, psychological and social quality of life (P <0.05). At the 8th week, lactulose long-term group and short-term group were significantly improved compared with the control group, but there was no significant difference between the long-short-term group and the long- Short-term group and control group significantly improved, short-term group and the control group, the difference was not significant; the first 24 weeks lactulose long-term group were significantly better than the control group and short-range group. ③ At 16 and 24 weeks after treatment, the blood ammonia in long-term lactulose group was significantly lower than that in control group and lactulose short-term group, the difference was significant. Conclusion: Lactulose long-term maintenance therapy can improve the quality of life of patients with mild hepatic encephalopathy, reduce the incidence of hepatic encephalopathy, reduce the concentration of serum ammonia; short-term treatment to improve the quality of life is not obvious.