海口地区轻微肝性脑病PHES标准参考值范围的研究

Study on PHES standard reference value range of mild hepatic encephalopathy in Haikou

目的探讨海口地区轻微肝性脑病(MHE)肝性脑病心理测试评分(PHES)标准的参考值范围,为MHE的诊断提供参考。方法选取2021年12月至2022年12月海南省人民医院感染科收治的100例肝硬化患者(肝硬化组)作为研究对象,其中59例确诊为MHE,另选取同期无肝病成年志愿者300例作为对照组。比较两组受试者的临床资料,并进行多元线性逐步回归分析,建立经相应影响因素校正的PHES系统各测试预期正常参考值计算公式,以此为标准计算肝硬化组患者PHES系统分值,计算肝硬化患者MHE患病率及准确率,利用受试者工作特征曲线(ROC)评估PHES诊断肝硬化患者MHE的效能。结果两组受试者在性别、年龄、饮酒、吸烟和高血压方面比较差异均无统计学意义(P>0.05);肝硬化组患者的受教育年限为(9.96±3.14)年,明显低于对照组的(11.92±3.83)年,差异有统计学意义(P<0.05);肝硬化组患者PHES量表测试中数字连接试验(NCT)A及B、系列打点试验(SDT)、轨迹描绘试验(LTT)均明显高于对照组,数字符号试验(DST)明显低于对照组,差异均有统计学意义(P<0.05);经多元线性逐步回归分析结果显示,受教育年限、年龄与PHES量表呈线性回归,差异均有统计学意义(P<0.05);建立相应影响因素校正的PHES系统各测试预期正常参考值公式:NCT-A=28.46+0.527×年龄-1.284×受教育年限,NCT-B=49.13+1.043×年龄-2.397×受教育年限,DST=30.54-0.274×年龄+2.173×受教育年限,LTT=42.35+0.412×年龄-0.987×受教育年限,SDT=48.15+0.355×年龄-1.054×受教育年限;肝硬化患者中PHES系统分值小于4分的患者为56例,PHES诊断肝硬化患者MHE患病率为56.00%(56/100),准确率为94.92%(56/59);经ROC分析结果显示,PHES对肝硬化患者MHE诊断效能的曲线下面积(AUC)为0.930,95%CI:0.870~0.989,与ROC下方所覆盖的面积为0.5相比,差异有统计学意义(P<0.05)。结论本研究PHES系统中各项测试的正常参考值均以海口区入选的受试者为标准,建立了海口地区PHES标准参考值范围,更适于受测人群,能够增加PHES诊断MHE的准确性。

Objective To explore the reference value range of psychometric hepatic encephalopathy score(PHES)standard of Minimal hepatic encephalopthy(MHE)in Haikou,and to provide reference for the diagnosis of MHE.Methods A total of 100 patients with cirrhosis admitted to the Department of Infectious Diseases,Hainan Gener-al Hospital from December 2021 to December 2022(cirrhosis group)were selected as the study subjects,59 of whom were diagnosed with MHE,and 300 adult volunteers without liver disease were selected as the control group.The clini-cal data of subjects in the two groups were compared,and multiple linear stepwise regression analysis was performed to establish the formula for calculating the expected normal reference value of PHES system tests corrected by correspond-ing influencing factors.The PHES system score of patients with cirrhosis was calculated based on this standard,and the prevalence rate and accuracy rate of MHE in patients with cirrhosis were calculated.The efficacy of PHES in the diagno-sis of MHE in cirrhotic patients was evaluated using receiver operating characteristic(ROC)curves.Results There were no significant differences in gender,age,drinking,smoking,and hypertension between the two groups(P>0.05).The years of education in cirrhosis group was significantly lower than that in control group(P<0.05).In PHES scale test,number connection test(NCT)A and B,serial dotting test(SDT),and line tracing test(LTT)in cirrhosis group were sig-nificantly higher than those in the control group,the number digit symbol test(DST)of PHES scale in cirrhosis group was significantly lower than that in control group,with statistically significant differences(P<0.05).Multiple linear step-wise regression analysis revealed that the years of schooling,age,and PHES showed linear regression,and the differ-ence was statistically significant(P<0.05).Formulae of expected normal reference values for each test of PHES system corrected for corresponding influencing factors were established:NCT-A=28.46+0.527×age-1.284×ears of education,NCT-B=49.13+1.043×age-2.397×years of education,DST=30.54-0.274×age+2.173×years of education,LTT=42.35+0.412×age-0.987×years of education,SDT=48.15+0.355×age-1.054×years of education.There were 56 patients with cir-rhosis whose PHES system score was less than 4 points.The prevalence rate of MHE diagnosed by PHES in cirrhosis pa-tients was 56.00%(56/100),and the accuracy rate was 94.92%(56/59).According to ROC curve assessment,the diag-nostic efficacy of PHES for MHE in cirrhotic patients was as follows:area under receiver operating characteristic curve(AUC)=0.930,95%CI:0.870-0.989,which was significantly different from 0.5(the area covered under ROC curve),P<0.05.Conclusion In this study,the normal reference values of all tests in the PHES system are based on the selected subjects in Haikou,and the standard reference range of PHES in Haikou is established,which is more suitable for the subject group and can increase the accuracy of PHES in the diagnosis of MHE.