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目的调查酒泉地区轻微肝性脑病(MHE)发病率,并观察中西医结合干预的效果。方法从2009年1月至2013年12月在酒泉市人民医院就诊的患者中连续抽取431例连续的慢性乙型病毒性肝炎肝硬化患者作为轻微肝性脑病流行病学调查研究对象。期间无神经精神性疾病和心理性疾病,未服用镇静剂、麻醉剂的400例健康人组成正常对照组,以正常对照组智力测验结果为正常参考值范围。对2012年1月至2012年12月诊断的MHE患者71例,按就诊先后顺序随机分为治疗A组36例,治疗B组35例。治疗A组给予乳酸菌素片3片,3次/d,口服;大黄10 g,开水泡服,2次/d。对照组给予乳果糖15~30 mg,1~3次/d,口服,根据大便次数(维持在1~2次/d)调整剂量。疗程均为24周。分别在用药前、停药后进行肝功能检查、数字连接试验(NCT)及数字符号试验(DST)测试。结果 MHE的患病率为43.9%,Child-pugh A、B、C级患者间的MHE患病率分别为27.9%、44.5%、62.5%,3组患病率之间差异有统计学意义(P<0.01)。Logistic回归分析显示,MHE患病率与年龄、性别、吸烟无关(P均>0.05),而与肝功能Child-pugh分级相关(P<0.01)。治疗A组总有效率为88.9%,治疗B组为85.7%,两组比较差异无统计学意义(P>0.05);治疗A组成本-效果比为3.8,治疗B组为19.6。结论 (1)NCT和DST两项检查简单易行,可操作性强,非常适合于MHE流行病学调查。(2)大黄水联合乳酸菌素片预防MHE,其成本-效果比低于乳果糖,且有与乳果糖相同的疗效,能使智力指标改善。
Objective To investigate the incidence of mild hepatic encephalopathy (MHE) in Jiuquan area and to observe the effect of integrated traditional Chinese and western medicine. Methods From January 2009 to December 2013, 431 consecutive patients with chronic hepatitis B cirrhosis were selected as the epidemiological study of mild hepatic encephalopathy in patients treated in Jiuquan People’s Hospital. During the period, there were no neuropsychiatric diseases and psychological diseases, and 400 healthy people who did not take sedatives and anesthetics formed the normal control group. The normal control group’s intelligence test results were normal reference value range. 71 cases of MHE patients diagnosed from January 2012 to December 2012 were randomly divided into treatment group A (36 cases) and treatment group B (35 cases). Treatment group A given lactobacillus tablets 3, 3 times / d, oral; rhubarb 10 g, blisters, 2 times / d. Control group was given lactulose 15 ~ 30 mg, 1 ~ 3 times / d, orally, according to stool frequency (maintained at 1 or 2 times / d) to adjust the dose. The course of treatment was 24 weeks. Respectively before treatment, after stopping the liver function tests, digital connection test (NCT) and digital sign test (DST) test. Results The prevalence of MHE was 43.9%. The prevalences of MHE between Child-pugh A, B and C patients were 27.9%, 44.5% and 62.5%, respectively. There was significant difference between the three groups P <0.01). Logistic regression analysis showed that the prevalence of MHE was not related to age, sex and smoking (P> 0.05), but correlated with Child-pugh classification of liver function (P <0.01). The total effective rate was 88.9% in treatment group A and 85.7% in treatment group B, with no significant difference between the two groups (P> 0.05). The cost-effectiveness ratio was 3.8 in treatment A group and 19.6 in treatment B group. Conclusions (1) The two tests of NCT and DST are simple and easy to operate, and are very suitable for MHE epidemiological investigation. (2) rhubarb water combined with lactobacillus tablets to prevent MHE, the cost-effectiveness ratio lower than lactulose, lactulose and have the same effect, can make mental indicators improve.