Novel computerized psychometric tests as primary screening tools for the diagnosis of minimal hepatic encephalopathy

Minimal hepatic encephalopathy(MHE)is a critical neurocognitive complication of decompensated liver cirrhosis and portosystemic shunting,which results in a wide range of cognitive deficits including impairments in working attention,psychomotor speed,and executive function.Current guidelines have recommended paper-and-pencil psychometric tests for the diagnosis of MHE.Most high-risk cirrhotic patients are required to be examined;however,paperand-pencil psychometric tests are neither convenient nor rapid to perform in the clinic.Recently,novel computerized psychometric tests,including the inhibitory control test,EncephalApp Stroop App,and critical flicker frequency,have been proven to be rapid,effective,and convenient methods for screening MHE in clinical practice and for identifying high-risk cirrhotic patients for further validation using rigid neuropsychometric examinations.However,diagnostic accuracy of these tests is influenced by educational background,age,and cultural differences.This review summarizes clinical evidence of the application of novel computerized psychometric tests for screening MHE.

手机版斯特鲁谱测试在筛查轻微型肝性脑病中的应用价值

目的评价手机版斯特鲁谱测试在筛查轻微型肝性脑病（MHE）中的应用价值。方法选择安徽医科大学附属省立医院感染科病房自2015年1月至2016年2月收治、无显性肝性脑病（OHE）的90例乙肝性肝硬化患者作为肝硬化组，另外选择本院同期体检中心的90例健康志愿者作为对照组，分别完成肝性脑病心理测试评分（PHES）量表及斯特鲁普测试。以对照组建立PHES系统5个测试项目的预期正常参考值公式。斯特鲁谱测试分off阶段和on阶段：以PHES测试作为诊断MHE的金标准，总得分小于-4分则诊断为MHE．比较肝硬化组和对照组、非MHE组和MHE组的测试结果；受试者工作特征（ROC）曲线分析手机版斯特鲁谱测试诊断MHE的敏感度及特异度。结果肝硬化组在斯特鲁普测试中总off阶段、总on阶段用时较对照组长．差异有统计学意义（P〈0．05）。以PHES总分小于-4作为MHE诊断标准，90例肝硬化患者中52例诊断为MHE。52例MHE患者在斯特鲁普测试中总off阶段、总on阶段用时较非MHE患者长，差异有统计学意义（P〈O．05）。完成测试所需要的次数较非MHE患者增多。ROC分析提示斯特鲁谱测试具有较好的有效性及可靠性，敏感度为87％、特异度为79％。结论手机版斯特鲁普测试是一种有效、省时和可靠的筛查MHE的方法。