数字连接试验对轻微肝性脑病诊断价值及肝硬化并发肝性脑病相关因素分析

Diagnostic value of number connection test for minimal hepatic encephalopathy and related factors of cirrhosis complicated with hepatic encephalopathy

目的探讨数字连接试验(NCT)对轻微肝性脑病(MHE)的诊断价值,分析肝硬化患者并发MHE的相关因素。方法选取自2017年12月至2019年10月于北部战区空军医院消化内科住院治疗并符合测试标准的156例肝硬化患者为研究对象。所有患者均行NCT测试及血氨检测,并同时进行性格精神测试。通过单因素χ2检验及多因素Logistic回归模型分析谷丙转氨酶(ALT)、谷草转氨酶、同型半胱氨酸、5′-核苷酸酶、前白蛋白、白蛋白、超敏C蛋白、钙离子、胱抑素-C(CYS-C)、血尿酸等指标与肝硬化并发MHE的关系。结果NCT试验诊断MHE的阳性率优于血生化中血氨检测及性格精神测试,差异有统计学意义(P<0.05)。单因素分析显示,ALT、同型半胱氨酸、5′-核苷酸酶、前白蛋白、CYS-C异常与肝硬化并发MHE显著相关。进一步行多因素分析显示,ALT、CYS-C异常是肝硬化患者并发MHE的独立相关因素。结论NCT试验对MHE的早期诊断具有临床意义,ALT、CYS-C异常是肝硬化患者并发MHE的独立相关因素。

Objective To investigate the diagnostic value of number connection test(NCT)for minimal hepatic encephalopathy(MHE),and to analyze the related factors of MHE in patients with cirrhosis.Methods A retrospective study was performed on 156 cases of patients with cirrhosis who were admitted from December 2017 to October 2019.All patients underwent NCT test and blood ammonia test,personality and spiritual testing simultaneously.The relationship between alanine aminotransferase(ALT),aspartate aminotransferase(AST),homocysteinemia(Hcy),5′-nucleotidase(5′-NT),pre-albumin(PA),albumin(ALB),high-sensitivity protein C(CRP),calcium ion(Ca2+),cystatin-C(CYS-C)and serum uric acid were analyzed by univariateχ2 test and multivariate logistic regression model.Results The positive rate of MHE diagnosed by NCT test was better than that of blood ammonia detection in blood biochemistry and personality and spiritual test,and the difference was statistically significant(P<0.05).Univariate analysis showed that abnormalities of ALT,Hcy,5′-NT,PA and CYS-C were significantly correlated with MHE in cirrhosis.Further multivariate analysis showed that abnormal ALT and CYS-C were independent related factors for MHE in patients with cirrhosis.Conclusion The NCT test has clinical significance for the early diagnosis of MHE,ALT and CYS-C abnormalities are independent related factors of MHE in patients with liver cirrhosis.