The Role Of Probiotics On Patients With Minimal Hepatic Encephalopathy Of Cirrhosis

Background and Objective: Minimal hepatic encephalopathy(MHE)is an early manifestation of hepatic encephalopathy.It can can be found only by fine psychological tests or neurophysiological examinations.It has a significant impact on patients' quality of life and daily activities.It is important for early detection and early treatment.This study aims to analyze the basic data of MHE in patients with cirrhosis and to understand the effect of probiotics on MHE and its influencing factors.Methods:109 patients with mild hepatic encephalopathy of cirrhosis in our hospital were enrolled.The age is range 18 to 70 years old.Each patient needed to finish Number Connection Test-A(NCT-A)and Digit Symbol Test(DST),which are both positive and MHE can be diagnosed.we recorded the gender,age,etiology,and serum Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),prothrombin time(PT),plasma ammonia,international standardization ratio(INR),Activated partial thromboplastin time(APTT),total bilirubin,serum albumin,lymphocyte count,serum creatinine and other clinical data to assess the basic situation of MHE.The above-mentioned patients were divided into experimental group and control group according to the randomization method.Both groups were treated with conventional treatment,such as reasonable rest,alcohol prohibition,liver protection,low protein diet,smooth stool,anti-virus treatment and so on.The experimental group was treated with Bacillus subtilis enteric-coated capsules on the basis of conventional treatment.The course of treatment was one month.Then the plasma ammonia concentration,ALT,AST,Child-Push score,Changes in the Model of End-stage liver disease score(MELD),NCT-A,and DST were compared before and after the experimental group,and the incidence of Overt hepatic encephalopathy(OHE),gastrointestinal bleeding and death was compared between the two groups after the test.So we could assess the role of probiotics in patients with MHE of cirrhosis.And the factors affecting the therapeutic effect of probiotics on MHE were analyzed.Results: 101 patients completed the experiment,and 8 patients were lost to follow-up.2 patients in the experimental groups developed overt hepatic encephalopathy.In the control group,2 patients developed gastrointestinal bleeding and 2 patients died.There were 3 patients with overt hepatic encephalopathy.According to statistical analysis,we found there were no statistical differences in sex,age,AST,ALT,plasma ammonia,NCT-A,DST,MELD,Child-Push score,total bilirubin and INR(P>0.5).After treatment with probiotics,the ALT,AST,plasma ammonia,Child-Push score,MELD,NCT-A,DST of experimental group decreased.Compared with the control group,there were statistically significant(P<0.05).The plasma ammonia,ALT,Child-Push score,MELD,NCT-A and DST were decreased significantly compared with the control group and the difference was statistically significant(P<0.05).In addition,there was no statistically significant difference in the incidence of OHE,gastrointestinal bleeding and death of experimental group compared with the control group(P>0.5).Logistic regression analysis showed that ascites and Child-Push classification were independent factors.Conclusion:Probiotics were effective treatment for MHE,which helped to improve ALT,AST,NCT-A,DST,MELD,Child-Push scores,plasma ammonia concentration and neuropsychological test scores.Unfortunately,there was no difference between the two groups in improving patients with dominant hepatic encephalopathy and gastrointestinal bleeding.It was found that ascites and Child-Push classification were independent factors influencing the efficacy of patients.