简化版肝性脑病心理测试评分量表对轻微型肝性脑病转归的预测价值

Predicting value of simplified psychometric hepatic encephalopathy score for transfer of minimal hepatic encephalopathy

目的探讨简化版肝性脑病心理测试评分(SPHES)量表对轻微型肝性脑病(MHE)转归的预测价值。方法选取安徽医科大学附属省立医院感染科自2015年1月至2016年3月收治的无显性肝性脑病(OHE)的乙肝肝硬化患者150例为试验组,同期健康体检中心志愿者150例为健康组。以肝性脑病心理测试评分(PHES)量表为金标准,分别采用SPHES量表和PHES量表筛查MHE的患病率。对患者进行24个月的随访,筛查OHE的发生。结果 PHES量表和SPHES量表筛查试验组患者MHE的患病率分别为41.3%(62/150)、35.3%(53/150),二者对MHE的诊断差异无统计学意义(P=0.342)。对试验组患者进行24个月随访,36例发展为OHE,其中SPHES量表和PHES量表诊断的MHE发生OHE分别为29例和27例,二者比较差异无统计学意义(P=0.136)。以PHES量表为金标准,Kaplan-Meier回归、COX回归分析提示SPHES量表对MHE的转归具有良好的预测价值(均P<0.01)。SPHES和PHES预测OHE发生的曲线下面积(AUC)分别为0.798和0.703。结论 SPHES量表对MHE转归具有良好的预测价值,且临床操作更简单易行。

Objective To observe the predicting value of simplified psychometric hepatic encephalopathy score(SPHES)for transfer of minimal hepatic encephalopathy(MHE).Methods One hundred and fifty hepatitis B cirrhotic patients without overt hepatic encephalopathy(OHE)admitted to Affiliated Provincial Hospital of Anhui Medical University from January 2015 to March 2016 were selected as test group,and 150 controls admitted to Medical Examination Centre at the same time were selected as health group.The psychometric hepatic encephalopathy score(PHES)was used as a standard.The prevalence of MHE was detected by SPHES and PHES separately.Patients were followed up for the development of OHE with 24 months.Results The prevalence of MHE was 41.3%(62/150)and 35.3%(53/150)respectively in the PHES scale and SPHES scale screening test group.There was no significant difference in the diagnosis of MHE(P=0.342).The patients in the test group were followed up for 24 months and 36 cases developed into OHE.Among them,29 cases and 27 cases were diagnosed with MHE by SPHES scale and PHES scale respectively.There was no statistically significant difference between the two scales(P=0.136).The PHES scale was used as the gold standard,Kaplan-Meier regression and COX regression analysis suggested that the SPHES scale has a good predictive value for the conversion of MHE(all P<0.01).The area under the curve(AUC)value of receiver operating characteristic(ROC)curve analysis was 0.798 and 0.703 respectively in PHES and SPHES for the prediction of OHE.Conclusion SPHES is useful for predicting the occurrence of MHE,which consumes less time and is more suitable for clinical screening.