斯特鲁普测试对肝硬化合并轻微型肝性脑病的诊断价值

The diagnostic value of Stroop test in liver cirrhosis with minimal hepatic encephal-opathy

目的:评估斯特鲁普(Stroop)测试对肝硬化合并轻微型肝性脑病(MHE)的诊断价值,初步探究Stroop测试联合其他神经心理学测试对MHE的诊断效能。方法:选取185例肝硬化患者作为肝硬化组,277例健康体检者作为健康组。两组人群均完成数字连接试验A(NCT-A)和数字连接试验B(NCT-B),肝硬化组患者还需完成Stroop测试和动物命名测试(ANT)。以NCT-A、NCT-B和ANT均异常作为MHE的诊断标准,将肝硬化组患者分为单纯肝硬化组和肝硬化MHE组。利用ROC曲线分别分析单用Stroop测试、Stroop测试联合NCT-A/NCT-B/ANT诊断策略对MHE的诊断价值,建立交叉表评价上述不同诊断方法对MHE的诊断效能。结果:185例肝硬化患者中有58例(31.35%)诊断为MHE。ROC曲线分析显示,Stroop测试指标中的Off time+On time取诊断临界值212.199 s时可以最好地识别MHE,AUC、敏感性和特异性分别为0.762(P<0.05)、79.3%和61.4%;Stroop测试联合NCT-A/NCT-B/ANT的不同序列试验方法对诊断MHE的AUC分别为0.873、0.834、0.845。交叉表分析发现,与单用Stroop测试相比,上述联合诊断策略可显著改善对MHE的诊断效能,其中,Stroop测试联合NCT-A对诊断MHE的正确率最优。结论:Stroop测试对诊断MHE具有良好的敏感性、特异性及AUC,是一项简便、有效的MHE诊断工具。Stroop测试联合NCT-A可能是一种更加有效的诊断MHE的新策略。

Objective:To evaluate the value of Stroop test in the diagnosis of the liver cirrhosis with minimal hepatic encephalopathy(MHE)and the diagnostic efficacy of Stroop test combined with other neuropsychological tests for MHE.Methods:A total of 185 cirrhotic patients were recruited as the research subjects and recorded as the liver cirrhosis group.In addition,277 healthy subjects were selected as the healthy group.Both groups completed the number connection test A(NCT-A)and the number connection test B(NCT-B),and the liver cirrhosis group also needed to complete the Stroop test and the animal naming test(ANT).With abnormal NCT-A,NCT-B and ANT as the diagnostic criteria for MHE,the liver cirrhosis group was divided into the simple liver cirrhosis group and the liver cirrhosis with MHE group.ROC curve was used to analyze the diagnostic value of Stroop test alone,Stroop test combined with NCT-A/NCT-B/ANT in the diagnosis of MHE,and a cross-table was established to evaluate the diagnostic efficacy of these different diagnostic methods in MHE.Results:Fifty-eight cases(31.35%)of 185 cirrhosis patients were diagnosed as MHE.The ROC curve analysis showed that MHE was best identified when the diagnostic critical value of 212.199 s was taken as the Off time+On time in the Stroop test index,and the AUC,sensitivity and specificity were 0.762(P<0.05),0.793 and 0.614,respectively.The AUCs of different sequence test methods of Stroop test combined with NCT-A/NCT-B/ANT for diagnosing MHE were 0.873,0.834 and 0.845,respectively.Crosstabs analysis showed that compared with the Stroop test alone(the value of Off time+On time was 212.199 s),the above combined diagnostic strategy could significantly improve the diagnostic performance of MHE.Among them,the Stroop test combined with NCT-A is optimal for the accuracy of diagnosing MHE.Conclusion:The Stroop test has good sensitivity,specificity and AUC for the diagnosis of MHE,and is a simple and effective diagnostic tool for MHE.The combination of Stroop test and NCT-A may provide a more effective new strategy for diagnosing MHE for future clinical practice.