LATENT HEPATIC ENCEPHALOPATHY IN PATIENTS WITH MINIMUM HEPATIC FIBROSIS

Abstract

Study objective. To evaluate effect of peroral administration of L-ornitin-L-aspartate (LOLA) on the frequency of road traffic accidents in persons with hepatic disease at the pre-cirrhotic stage. Material and methods. The study included 42 patients – men aged 25-45, drivers with the driving experience no less than 3 years acknowledged guilty of 3-4 road traffic accidents in the recent 3 years. All patients were diagnosed with chronic hepatitis C (genotype 1), with minimum or low activity of aminotransferase and the minimum hepatic fibrosis. Diseases that could affect performance of the road traffic accident as well as external factors (state of the car, road surfacing, weather conditions). LOLA therapy at a dosage 9 g per day was done by 2-month cycles with 2-month intervals, by the present moment the total duration reached 5 months. Each month biochemical blood analysis, blood ammonium ion concentration determination and psychometric tests were performed. Results. Ammonium ion concentration was reduced in a month after start of LOLA (from 145.4 μmol/l to 130.3 μmol/l, р = 0,016) maintaining stable tendency to reduction during the therapy until achievement of the medium level 90.4 μmol/l (р = 0.003) by the 6th month. Results of the flicker fusion frequency test significantly improved by the end of the first course LOLA (р = 0,003), remaining at the achieved level during the therapy. The results of the number connection test significantly improved by the end of the first month of therapy (р < 0.001), with maintenance of the trend on the background of the ubsequent courses. In the specified period of observation no road traffic accidents through the fault of persons included in the study, according to the data of the STSI. Conclusions. The intermitting LOLA therapy in patients with chronic hepatitis C and the minimum fibrosis reconditions quick reduction of the ammonium ion concentration in the blood and significant improvement of psychometric tests values.

Keywords

• ammonia
• hepatic encephalopathy
• chronic hepatitis c
• l-ornitin-l-aspartate