Probiotic yogurt for the treatment of minimal hepatic encephalopathy
Probiotic yogurt for the treatment of minimal hepatic encephalopathy
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DOI：
10.1111/j.1572-0241.2008.01861.x
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发表时间：
2008-07-01
影响因子：
9.8
通讯作者：
Binion, David G.
中科院分区：
文献类型：
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作者：
Bajaj, Jasmohan S.;Saeian, Kia;Binion, David G.
目的：轻度肝性脑病（MHE）是显性肝性脑病（OHE）的临床前阶段，是影响高达60%肝硬化患者的重要疾病。所有MHE疗法都能改变肠道菌群，但关于MHE治疗和长期依从性研究缺乏共识。目的是确定以食物形式补充益生菌，益生菌酸奶，对MHE逆转和依从性的影响。方法：非酒精性MHE肝硬化患者（由标准心理测量量表定义）以非盲法随机分配，以2:1的比例接受益生菌酸奶（已证实培养稳定性）或不治疗（不服用Rx） 60天。还测量了生活质量（简称[SF]-36）、依从性、静脉氨、终末期肝病模型（MELD）评分和炎症标志物（肿瘤坏死因子[TNF]- α、白细胞介素[IL]-6）。结果是采用盲法评分的MHE逆转、OHE发展和依从性。结果：纳入25例患者（17例酸奶，8例无Rx； 84%为儿童A级）。与不服用Rx的患者相比，酸奶患者逆转MHE的比例明显更高（71%对0%，P = 0.003，意向治疗）。酸奶患者在数字连接测试- a （NCT-A）、块设计测试（BDT）和数字符号测试（DST）方面与基线/无Rx组相比有显著改善。在试验期间，25%的不服用Rx的患者和0%的酸奶患者出现了OHE。88%的酸奶患者是粘连的。未观察到不良反应或协变量的变化。如果需要，所有完成酸奶组的患者都同意继续使用酸奶6个月。结论：该试验表明，在补充益生菌酸奶后，肝硬化患者的MHE逆转率显著，并具有良好的依从性，并有可能长期坚持。
OBJECTIVES: Minimal hepatic encephalopathy (MHE), the preclinical stage of overt hepatic encephalopathy (OHE), is a significant condition affecting up to 60% of cirrhotics. All MHE therapies modify gut microflora, but consensus regarding MHE treatment and long-term adherence studies is lacking. The aim was to determine the effect of probiotic supplementation in the form of a food item, probiotic yogurt, on MHE reversal and adherence.METHODS: Nonalcoholic MHE cirrhotics (defined by a standard psychometric battery) were randomized with unblinded allocation to receive probiotic yogurt (with proven culture stability) or no treatment (no Rx) for 60 days in a 2:1 ratio. Quality of life (short form [SF]-36), adherence, venous ammonia, model of end-stage liver disease (MELD) scores, and inflammatory markers (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6) were also measured. Outcomes were MHE reversal using blinded scoring, OHE development, and adherence.RESULTS: Twenty-five patients (17 yogurt, 8 no Rx; 84% Child class A) were enrolled. A significantly higher percentage of yogurt patients reversed MHE compared to no Rx patients (71% vs 0%, P = 0.003, intention-to-treat). Yogurt patients demonstrated a significant improvement in number connection test-A (NCT-A), block design test (BDT), and digit symbol test (DST) compared to baseline/no Rx group. Twenty-five percent of no Rx versus 0% of yogurt patients developed OHE during the trial. Eighty-eight percent of yogurt patients were adherent. No adverse effects or change in covariates were observed. All patients who completed the yogurt arm were agreeable to continue yogurt for 6 months if needed.CONCLUSIONS: This trial demonstrated a significant rate of MHE reversal and excellent adherence in cirrhotics after probiotic yogurt supplementation with potential for long-term adherence.