肝硬化和重症肝炎患者日常行为异常与轻微肝性脑病关系的探讨

The relationship between the daily behavior abnormalities and minimal hepatic encephalopathy in patients with cirrhosis or liver failure

[目的]探讨肝病患者日常行为能力异常筛查可疑轻微肝性脑病(MHE)的价值。[方法]509例住院肝病患者(肝硬化435例,肝衰竭74例),应用疾病影响程度量表(SIP)调查日常行为能力(包括7类21项日常生活行为);采用Child-Pugh分级法评价肝硬化患者肝功能严重程度;应用对照值经过年龄和文化程度矫正的数字连接测试和数字符号测试诊断MHE。采用χ2检验比较MHE阳性和MHE阴性患者日常行为能力异常情况,采用多元Logistic回归分析患者日常行为能力异常与MHE相关性。[结果]142例被诊断为MHE阳性患者(阳性率27.90%);21项生活能力中,MHE患者15项下降较MHE阴性患者明显(P<0.05~P<0.01)。其中"帮助他人兴趣下降"(P=0.01)、"会犯糊涂"(P=0.002)、"容易遗忘"(P=0.031)与MHE相关。[结论]肝硬化、肝衰竭患者部分日常行为能力下降与MHE相关,通过调查肝病患者日常行为可较好发现可疑的MHE患者。

[Objective]Evaluate the value of the abnormal behaviors on predicting the of minimal hepatic encephalopathy（MHE）in patients with liver diseases. [Methods]A totals of 509 inpatients with liver disea- ses（435 cirrhosis,74 liver failure）and 843 healthy were involved in the study. The daily behavior was evalu- ated by using Sickness Impact Protile（SIP）questionnaire. The liver function was graded by Child-Pugh score. MHE was diagnosed by using psychometric tests with age and education corrected normal values （NCT and DST）. Multiple Logistic regression analysis was used to analyze the relationship between the de- cline of daily behavior and MHE. [Results]The 142 patients with Hepatology were diagnosed with MHE （positive rate 27. 900//00）. Among the 21 categories of life skills,MHE patients decreased more significantly in the 15 categories compares with MHE negative（P（0.05--P（0.01）. ＂Declining interest in helping oth- ers＂（P = 0.01）, ＂I am confused＂ （P = 0. 002）＂I forget a lot＂ （P = 0. 031）were associated with the MHE. I-Conclusion]Cirrhosis and liver failure in patients with part of daily behavior decline and MHE are correlated were related, by investigating the daily behavior of patients with liver disease can be detect suspicious MHE.