Experimental Study on Preventive and Therapeutic Effect of Chinese Traditional Compound Medicine to Subclinical Hepatic Encephalopathy in Liver Cirrhotic Rats / 医学研究杂志

Objective To study the preventive and therapeutic effects and the mechanism of Chinese traditional compound medicine to subcilincal hepatic encephalopathy(SHE)induced by endotoxin in liver cirrhotic rats.Methods The liver cirrhosis model of rats were made in subcutaneous injection of 40% carbon tetrachloride,the SHE model was made by infused with endotoxin into the tail vein.Treatment group was given low dose or moderate dose or high dose of Chinese traditional compound medicine,Control group was treated with lactulose.The morbidity of SHE,hepatic function,blood ammonium(BA),endotoxin,liver tissue pathology were observed.Results Above indexes were improved by every group of Chinese traditional compound medicine.The curative effect of moderate and high group of Chinese traditional compound medicine to the hepatic function,BA,endotoxin,liver tissue pathology were better than that of lactulose.Conclusions The effects of the Chinese traditional compound medicines(compose of Polygonum cuspidatum,raw hawthornfruit,seed of Zizyphus jujuba Mill,Mongolian Dandelion Herb and Rhizoma Acoori Graminei)in SHE prevention and treatment is significant.Its mechanism might be as follows:① recovering liver function,decreasing inflammatory changes of liver tissue;② preventing the absorption of BA,lowering the content of BA;③ reducing the sensitivity of the body to endotoxin.

A Clinical Study on Therapeutic Effect of Chinese Traditional Compound Medicine on Subclinical Hepatic Encephalopathy / 医学研究杂志

Objective To observe the therapeutic effects of Chinese traditional compound medicine on subcilincal hepatic encephalopathy(SHE).Methods 52 patients with liver cirrhosis complicated by SHE were randomly divided into treatment group and control group.The patients of control group received conventional hepatoprotection treatment,and the patients of treatment group were given conventional treatment and Chinese traditional compound medicines.Number connection test(NCT),electroencephalogram(EEG),liver function,blood ammonia were investigated after 2 weeks of treatment.Results The number connection test (NCT),electroencephalogram (EEG),liver function,blood ammonia were significantly improved in the treatment group than that in the control group(P

The Effects of the Regulation by Intestinal Probiofics and Fermantative Microflora on the Subclinical Hepatic Encephalopathy(SHE) of the Patients with Hepatocirrhosis / 医学研究杂志

Objective To investigate the therapeutic effect and its mechanisms on the treatment of subclinical hepatic encephalopathy(SHE)caused by hepatocirrhosis(compensatery phase)due to hepatitis B by Bifido(Haisi pharmacy).Methods 50 cases were randomized into therapeutic group and control group wtih twenty-five patients each.Patients in therapeutic group were given Bifido two capsule pills t.i.d in addifion to conventional therapy,while patients in controgroup were given the conventional therapy namely soft food with low salt,protective drugs for liver and supporting therapy.The therapeutic course in two groups was 8 weeks.We observed the changes of clinical symptoms,signs,arterial blood ammonia level,hepatic functions,number connection test(NCT) and other indexes prior to treatment and 4,8 weeks after treatment.Results It showed that Bifido capsules could not only improve the clinical symptoms,signs,Child-Turcotte-Pugh function grade,but also could decrease arterial blood ammonia,LPS level and time of number connection fest and the occurrence of HE(P

Psychiatric Characteristics and Diagnosis of SHE in Patients with Liver Cirrhosis:Cognitive Functions and Evoked Potentials / 신경정신의학

OBJECTIVES: This study was designed to elucidate the psychiatric characteristics and nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy(SHE) in patients with non-alcoholic liver cirrhosis. And also the authors prospectively studied the role of somatosensory evoked potentials(SEP) in the assessment of SHE. METHODS: Beck Depression Inventory(BDI) for measuring depression, State Trait Anxiety Inventory(STAI) for measuring anxiety, and Health-related Quality of Life Questionnaire(HQLQ) for measuring quality of life were administered the 41 non-encephalopathic liver cirrhosis patients(NELC) group and 31 carefully matched normal controls. And a prospective study to compare the performance of NELC group and normal controls on a short but comprehensive cognitive tests was conducted. After several cognitive tests, NELC group was divided into two groups, SHE group and non-SHE group by results of digit symbol substitution test(DSST) and/or trail making test(TMT) A and B. And then median nerve evoked cortical responses in 13 SHE patients group, 11 non-SHE patients group, and 8 normal controls were recorded for latencies of N13, P16, N20, P25, N30, P45, N65, and P95. And also responses for N13-N20 interpeak latency(IPL) and N20-N65 IPL were recorded. RESULTS: There were significant differences between the NELC group and normal controls on BDI, trait anxiety scales in STAI, and almost all HQLQ except for the cognitive function, social interaction and life satisfaction(p<0.05). The NELC group exhibited poor performance in DSST, TMT A and TMT B compared with normal controls(p<0.05). As 17 NELC patients had abnormal cognitive test results, 41.5% of cirrhotic patients had SHE. In SEP assessment, NELC group with SHE and without SHE had higher N20-N65 IPL and only NELC group with SHE had higher N65 latency compared with normal controls(p<0.05). CONCLUSION: This study suggests that the patients with liver cirrhosis exhibit relatively selective deficits in complex attentional and fine motor skills, with preservation of general intellectual ability, memory, language and visuospatial perception. DSST, TMT A and TMT B seem to be useful screening tests for the detection of SHE. And also it is expected that late components and N20-N65 IPLs of SEP are helpful in the assessment of SHE.

Correlation of Cognitive Function and Proton Magnetic Resonance Spectroscopic(1H MRS) Findings in Subclinical Hepatic Encephalopathy / 신경정신의학

OBJECTIVES: To investigate the relationship of neurochemical changes of brain in SCHE patients and the level of cognitive function, the authors measured hydrogen containing neurochemicals in two brain regions using 1H MRS, and compared those changes with the level of cognitive performances such as attention, visual analysis, or fine motor function. METHODS: A total of patients with liver cirrohosis were defined as SCHE, for they performed poorly(out of 1 SD of normative data) in more than one neuropsychological tests conventionally used(digit symbol and block design tests in KWIS, trail making test A and B). They were further evaluated in attentional ability and efficacy of visual analysis using Cognitrone subtest in Vienna Neurocognitive Test battery. Fine motor coordination were also measured by Grooved Pegboard test. Patients and 20 normal controls underwent proton MRS study. Proton containing neurochemicals, such as myoinositol(mI), N-acetyl-L-aspartate(NAA), creatine(Cr), choline(Cho) were measured from 2*2*2cm3 voxel of basal ganglia and parietal white matter using 1.5 tesla clinical MRI/MRS system. The ratios of above metabolites to Cr were analyzed. RESULTS: 1) Patients with SCHE showed reductions in Cho/Cr and mI/Cr in both basal ganglia and parietal white matter compared to normal subjects. 2) Performance of Grooved Pegboard test were negatively correlated with mI level of basal ganglia and with Cho level of parietal white matter(r=-0.59, p<.05). 3) Mean time of correct responses in Cognitrone test showed negative correlation with NAA level of parietal white matter(r=-0.55, p<.05). CONCLUSION: Certain neurocognitive disturbances in SCHE patients seemed to be related with neurochemical changes in basal ganglia or parietal white matter. To further elucidate the relationship of focal biochemical changes and neurocognitive deficits in SCHE patients, however, follow-up study according to the illness stage must be performed. Studies on other disorders showing similar cognitive deficit patterns would be helpful.

Effect of Qingkai Granule on patients with subclinical hepatic encephalopathy of intelligence test and evoked potential / 中成药

AIM: To explore the treatment of subclinical hepatic encephalopathy(SHE) by traditional Chinese medicine. METHODS: Sixty patients with SHE were randomized into two groups: treatment group with 30 cases treated by Qingkai Granule and control group with another 30 cases treated by lactulose.They were all treated for two weeks.The evoked potentials(Eps) were measured,moreover,number connection test(NCT) and digit symbol test(DST) were conducted. RESULTS: In treatment group,the period for NCT was shorter and the DST also improved apparently;peak latency(PL) and interpeak latency(IPL) of SEP and AEPs were shorter to different degrees,with significant differences among groups. CONCLUSION: Qingkai Granule acts to effectively increase the learning,memory and space cognitive capacities in patients,and improves the nerve electrophysiology in patients.

Neuropsychological Tests in Patients with Liver Cirrhosis / 中国心理卫生杂志

Objective:To explore the neuropsychological deficiency in patients with liver cirrhosis.Method:Sixty-nine patients with liver cirrhosis but no history of hepatic encephalopathy were tested with the neuropsychological test battery.Sixty-two normal controls were also tested with the same battery.Result:There was significant influence of age and education on the result of neuropsychological tests.Digit Symbol and Trailmaking test were the best tests discriminating patients and normal controls.When mean?2SD was defined as abonormal,34 8% patients were abnormal in Trailmaking and 14 3% in Digit Symbol.Conclusion:The neuropsychological tests may be a predictive tool for encephalopathy in patients with liver cirrhosis.