诱发电位对肝硬化患者轻微肝性脑病的诊断价值  

Diagnostic value of the evoked potentials in liver cirrhotic patients with minimal hepatic encephalopathy

作　　者：林言[1] 范燕萍[1] 余建军[2] 裘俊幼[3] 朱春霞[3] 

机构地区：[1]宁波市第二医院消化科,315010 [2]宁波市第二医院神经科,315010 [3]宁波市第二医院神经电位室,315010

出　　处：《中华消化杂志》2010年第7期444-447,共4页Chinese Journal of Digestion

摘　　要：目的 探讨诱发电位（EP）在没有症状性肝性脑病（OHE）的肝硬化患者中检测轻微肝性脑病（MHE）的价值.方法 对114例无OHE的肝硬化患者进行盲法、自身同步对照的数字连接试验A（NCT-A）、数字符号试验（DST）并检测视觉诱发电位（VEP）、脑干听觉诱发电位（BAEP）、体表感觉诱发电位（SSEP）、P300听觉事件相关诱发电位（P300ERP）.NCT-A和DST检测中1项异常即诊断为MHE,比较各EP检测的异常率,评估其诊断MHE的价值.结果 114例肝硬化患者中诊断MHE 60例（52.6%）,其阳性率与Child-Pugh分级呈等级正相关（r=0.278,P=0.003）.VEP、BAEP、SSEP、P300ERP异常率分别为17.5%、29.8%、38.6%、57.0%.仅P300ERP的异常率与NCT-A＋DST的阳性率差异无统计学意义（X2=0.432,P=0.511）.VEP、BAEP、SSEP、P300ERP的诊断敏感度分别为13.3%、41.7%、46.7%、73.3%,特异度分别为77.8%、83.3%、70.4%、61.1%.P300ERP的受试者工作特征曲线（ROC）下面积最大（0.672,95%CI 0.572～0.773）.VEP、BAEP、SSEP、P300ERP与NCT-A＋DST的符合率分别为43.9%、61.4%、57.9%、67.5%.各EP检测的Kappa值均〈0.39.结论 以P300ERP诊断无OHE的肝硬化患者MHE敏感度和特异度均较高.P300ERP不可替代NCT-A-4＋DST,但可作为补充检测手段.Objective To evaluate the value of evoked potentials （EP） in diagnoses of minimal hepatic encephalopathy （MHE） for liver cirrhotic patients without overt hepatic encephalopathy （OHE）. Methods A blind and self control study was conducted in 114 liver cirrhotic patients without OHE. All patients were tested for MHE by the number connection test-A（NCT-A）, digit symbol test （DST）, visual evoked potentials （VEP）, brain-stem auditoru evoked potentials （BAEP）, short latency somatosensory evoked potentials （SSEP）, P300 auditory event-related potentials （P300ERP）. MHE was identified when the NCT-A or/and DST was abnormal. The positive rate was compared among VEP, BAEP, SSEP and P300ERP for their reliability and validity in diagnosis of MHE. Results Of 114 patients, 60 patients were found with MHE （52. 6%）, which was positively correlated with Child-Pugh classifications （r=0. 278, P = 0. 003）. The positive rate was found 17.5% in VEP, 29.8% in BAEP, 38. 6% in SSEP and 57. 0% in P300ERP. There was no significant difference in diagnosis of MHE between P300ERP and NCT-A＋DST （X2 =0. 432,P = 0. 511）. The sensitivity of VEP, BAEP, SSEP or P300ERP for diagnosis of MHE was 13. 3%, 41. 7%, 46. 7% or 73. 3%, respectively, whereas the specificity was 77. 8%, 83. 3%, 70. 4% or 61. 1 %, respectively. The receiver operating characteristic curve revealed that the best sensitivity and specificity for the diagnosis of MHE was P300EERP （area under the curve was 0. 672, 95%CI 0. 572 ＊ 0. 773）. The agreement of NCT-A＋DST with VEP, BAEP, SSEP or P300ERP was 43. 9%, 61. 4%, 57. 9% or 67. 5%. Conclusions P300ERP is a sensitive and specific method for the diagnosis of MHE. which can serve as a supplement but not instead of NCT-A＋DST.

关 键 词：诱发电位 事件相关诱发电位 P300 肝性脑病 

分 类 号：R575.2[医药卫生—消化系统] R747.9[医药卫生—内科学]