静脉注射 L-鸟氨酸-L-天门冬氨酸对 III 级和 IV 级肝性脑病患者的疗效和安全性

IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of hepatology Pub Date : 2024-02-01 DOI:10.1016/j.aohep.2024.101441
Gabriela Rangel-Zavala, Laura V. Cupil- Escobedo, María F. Higuera-de la Tijera, José L. Pérez-Hernandez
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引用次数: 0

摘要

导言和目的肝性脑病(HE)是肝硬化常见的严重并发症,发病率和死亡率都很高。氨和炎症是肝性脑病的主要诱因。本研究旨在评估静脉注射 L-鸟氨酸-L-天门冬氨酸(LOLA)对 III-IV 级肝性脑病(HE)患者的疗效和安全性。材料和患者对 III-IV 级肝性脑病(HE)患者进行的回顾性分析研究。所有患者均接受 50 克 LOLA 静脉注射,最长 48 小时,不包括肾功能衰竭患者。研究采用了描述性统计方法,对中心倾向和离散程度进行了测量。如果 HE 至少下降了一个等级,则认为病情有所好转,并对不良反应进行评估。其中女性 13 人(40.6%),男性 19 人(59.4%)。8 名患者(25%)被归类为 Child-Pugh B,24 名患者(75%)被归类为 Child-Pugh C。最常见的病因与酒精有关(43.8%),其次是MAFLD(29.1%)和病毒(9.5%)。所有患者都患有 III 级肝性脑病。诱发因素包括败血症(53%)、出血(25%)、便秘(12.5%)、利尿剂(6.3%)和电解质失衡(3.1%)。共有 24 名患者(75%)对治疗有反应,8 名患者(25%)没有反应。19名患者出现了某种程度的急性-慢性肝功能衰竭(ACLF)。结论使用静脉注射 LOLA 治疗 III-IV 级肝性脑病既有效又安全。这些结果支持将 LOLA 作为治疗肝性脑病的一种选择。
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Efficacy and safety of intravenous L-ornithine L-aspartate in patients with grade III and IV hepatic encephalopathy

Introduction and Objectives

Hepatic encephalopathy (HE) is a common and serious complication of cirrhosis, associated with high morbidity and mortality. Ammonia and inflammation are the main triggers of HE. The use of L-ornithine-L-aspartate (LOLA) provides precursor substances for glutamine synthesis in perivenous cells, accelerating ammonia detoxification.

This study aims to evaluate the efficacy and safety of intravenous L-ornithine-L-aspartate (LOLA) in patients with grade III-IV hepatic encephalopathy (HE).

Materials and Patients

Retrospective and analytical study of patients with grade III-IV hepatic encephalopathy (HE).

All patients received intravenous LOLA 50 g for up to 48 hours, excluding those with renal failure. Descriptive statistics with measures of central tendency and dispersion were performed. Improvement was considered when HE regressed by at least one grade, and adverse events were evaluated.

Results

A total of 32 patients were included, with a mean age of 55 years ± 9.6. There were 13 females (40.6%) and 19 males (59.4%). Eight patients (25%) were classified as Child-Pugh B, while 24 patients (75%) were classified as Child-Pugh C. The mean MELD score was 19.03 ± 6.08, and the mean MELD NA score was 7.19 ± 7.19. The most common etiology was alcohol-related (43.8%), followed by MAFLD (29.1%) and viral (9.5%). All patients had grade III hepatic encephalopathy. The precipitating factors were sepsis (53%), hemorrhage (25%), constipation (12.5%), diuretics (6.3%), and electrolyte imbalance (3.1%). A total of 24 patients (75%) responded to the treatment, while 8 patients (25%) did not. Nineteen patients were found to have some degree of acute-on-chronic liver failure (ACLF). No adverse events were reported.

Conclusions

The use of intravenous LOLA for the treatment of grade III-IV hepatic encephalopathy iseffective and safe. These results support the use of LOLA as a therapeutic option in the management of hepatic encephalopathy in this patient population.

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来源期刊
Annals of hepatology
Annals of hepatology 医学-胃肠肝病学
CiteScore
7.90
自引率
2.60%
发文量
183
审稿时长
4-8 weeks
期刊介绍: Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.
期刊最新文献
Editorial board Global multi-societies endorsement of the MAFLD definition An Acknowledgement Biological aging accelerates hepatic fibrosis: Insights from the NHANES 2017-2020 and genome-wide association study analysis. Development of a biodegradable prosthesis through tissue engineering, for the organ-replacement or substitution of the extrahepatic bile duct
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