神经心理测量评分对肝硬化患者轻微型肝性脑病的诊断价值

Value of psychometric hepatic encephalopathy score in the diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis

目的探讨神经心理测量评分(PHES)诊断轻微型肝性脑病(MHE)的应用价值及其影响因素,调查肝硬化患者MHE的患病率及其危险因素。方法选取2011年4月-2012年4月于吉林大学中日联谊医院住院的年龄≥18岁的肝硬化患者138例(肝硬化组),以同期门诊体检或住院患者陪护家属、无肝病成年志愿者108例作为正常对照组。所有研究对象均进行PHES,通过正常对照组探讨各量表影响因素,明确该评分诊断MHE价值,并分析MHE患病的危险因素。计量资料2组间比较采用t检验或Wilcoxon秩和检验,计数资料2组间比较用χ2检验。2组连续变量相关性应用Pearson相关性分析,相关因素用多元线性逐步回归分析及logistic回归分析。结果 2组受试者在年龄、文化程度、饮酒、吸烟、职业方面比较差异无统计学意义(P值均> 0. 05)。正常对照组的年龄和受教育时间与PHES呈线性相关,且年龄越大(r=-0. 259)、受教育程度越低(r=0. 693),PHES测试成绩越差。建立PHES年龄、受教育程度相关各测试预期正常参考值公式为:数字连接试验-A(NCT-A)=30. 70+0. 631×年龄-1. 504×受教育时间,改良的数字连接试验-BC(NCT-BC)=54. 93+1. 134×年龄-2. 574×受教育时间,数字符号试验(DST)=29. 90-0. 332×年龄+2. 670×受教育时间,轨迹描绘试验(LTT)=48. 82+0. 496×年龄-1. 120×受教育时间,系列打点试验(SDT)=54. 35+0. 402×年龄-1. 266×受教育时间。肝硬化组患者PHES各测试结果与相应预期正常参考值相比较,无OHE患者的PHES分值[-5. 5(-2. 0～-7. 0)]比1期OHE患者[-10. 0(-7. 5～-13. 0)]显著增加(Z=3. 65,P <0. 01),无OHE患者和1期OHE患者的MHE患病率比较差异有统计学意义(52. 5%vs 80. 0%,χ2=4. 19,P <0. 05)。Logistic回归分析显示MHE患病率与ChildPugh分级明显相关(比值比=2. 30,95%可信区间:1. 46～3. 79,P <0. 01)。结论 PHES有利于MHE的早期诊断,但受年龄、受教育程度因素影响,Child-Pugh分级是MHE患病率重要的危险因素。

Objective To investigate the value of psychometric hepatic encephalopathy score(PHES)in the diagnosis of minimal hepatic encephalopathy(MHE)and related influencing factors,as well as the prevalence rate of MHE among patients with liver cirrhosis and related risk factors.Methods A total of 138 patients with liver cirrhosis aged≥18 years,who were hospitalized in China-Japan Union Hospital of Jilin University from April 2011 to April 2012,were enrolled as liver cirrhosis group,and 108 individuals who underwent physical examination during the same period of time,patients′family members,and adult volunteers without liver disease were enrolled as normal control group.PHES was determined for all subjects.The influencing factors for the scores on each scale were analyzed,the value of this score in the diagnosis of MHE was evaluated,and the risk factors for MHE were identified.The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Pearson correlation was used to analyze the correlation between continuous variables,and multivariate linear stepwise regression and logistic regression were used to analyze related factors.Results There were no significant differences in age,education level,drinking,smoking,and occupation between the two groups(all P>0.05).In the normal control group,age and years of education had a linear correlation with PHES,and PHES decreased with the increase in age(r=-0.259)and the reduction in education level(r=0.693).The formulas of the expected normal reference values of each test associated with age and education level were established as follows:number connection test-A(NCT-A)=30.70+0.631×age-1.504×years of education,modified number connection test-BC(NCT-BC)=54.93+1.134×age-2.574×years of education,digit symbol test(DST)=29.90-0.332×age+2.670×years of education,line-tracing test(LTT)=48.82+0.496×age-1.120×years of education,serial dotting test(SDT)=54.35+0.402×age-1.266×years of education.For the comparison of test results with corresponding expected normal reference values in the patients with liver cirrhosis,there were significant differences between the patients with stage I overt hepatic encephalopathy(OHE)and those without OHE in PHES(-5.5(-2.0 to-7.0)vs-10.0(-7.5 to-13.0),Z=3.65,P<0.01)and prevalence rate of MHE(52.5%vs 80.0%,χ2=4.19,P<0.05).The logistic regression analysis showed that the prevalence rate of MHE was significantly associated with Child-Pugh class(odds ratio=2.30,95%confidence interval:1.46-3.79,P<0.01).Conclusion PHES helps with the early diagnosis of MHE,but it is influenced by age and education level,Child-Pugh class is an important risk factor for the prevalence rate of MHE.