基于RBANS的乙肝后肝硬化患者认知功能测定及影响因素  

Determination of cognitive function of patients with liver cirrhosis caused by chronic hepatitis B based on RBANS and related factors

作　　者：王威巍[1] 邱海棠[2] 黄小兵[1] 梁平[1] 李靖[1] 王细文[1] 郑璐[1] 张宇[1] 

机构地区：[1]第三军医大学新桥医院肝胆外科,重庆400037 [2]重庆医科大学附属第一医院心理卫生中心,重庆400016

出　　处：《第三军医大学学报》2011年第19期2051-2054,共4页Journal of Third Military Medical University

摘　　要：目的应用RBANS量表测定乙肝后肝硬化患者的认知功能并初步研究可能影响RBANS评分的因素。方法选取2010年3月至2011年2月之间首次诊断为乙肝后肝硬化的患者56例及健康对照组50例,对所有患者及健康对照组进行RBANS量表测定,同时测定患者肝、肾功能主要指标及血氨值,分析其与RBANS量表评分之间的相关性。结果肝硬化患者RBANS量表测验总分、5个维度及11个子测试评分均明显低于健康对照组,且具有统计学意义(P<0.01);仅数字广度测验得分大于对照组,但无统计学意义。将血氨和肝功能中的白蛋白、总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶及肾功能中的尿素氮、肌酐及尿酸分别与RBANS的5个维度及12个子测试分别作相关分析,血氨及白蛋白与RBANS的5个维度及12个子测试均无相关性。而与总胆红素(r=0.571,P=0.042)、直接胆红素(r=0.572,P=0.041)、谷丙转氨酶(r=0.775,P=0.002)、谷草转氨酶(r=0.708,P=0.007)有相关性的为图形回忆,同时词汇学习子测试与谷丙转氨酶(r=0.765,P=0.002)及谷草转氨酶(r=0.602,P=0.029)有相关性,与BUN(r=-0.561,P=0.046)及尿酸(r=-0.608,P=0.036)存在负相关性的为词汇再识,与肌酐存在负相关性的为数字广度子测试(r=-0.557,P=0.048)及延迟记忆维度(r=-0.684,P=0.010)。结论乙肝后肝硬化患者存在着明显的认知功能障碍;乙肝后肝硬化患者的认知功能障碍可能与血氨及肝功能等级没有直接联系,与肾功能可能存在着一定的关系。Objective To detect the cognitive function of patients with liver cirrhosis caused by chronic hepatitis B using Repeatable Battery for the Assessment of Neuro-psychological Status（RBANS） and to preliminarily study potential factors influencing RBANS score.Methods Fifty-six patients who were diagnosed with liver cirrhosis caused by chronic hepatitis B at the first time from Mar 2010 to Feb 2011 and 50 healthy adults were enrolled.RBANS was applied to detect cognitive functions of the patients.The main indices of the hepatic function,renal function and blood ammonia were analyzed for their correlation with RBANS scores.Results The differences of the total scores,5 domains scores and 11 subtests scores of RBANS between the patients with liver cirrhosis and the healthy controls were statistically significant（P0.01）.Only digit span of the liver cirrhosis patients was higher than that of the healthy controls,but the difference was not significant.Correlation analysis was performed between 5 domains and 12 subtests of RBANS and blood ammonia,hepatic function indices of ALB,TB,DB,ALT and AST and renal function indices of urea nitrogen,creatinine and uric acid.Blood ammonia and ALB were not correlated with the 5 domains and 12 subtests of RBANS,while TB（r=0.571,P=0.042）,DB（r=0.572,P=0.041）,ALT（r=0.775,P=0.002） and AST（r=0.708,P=0.007） were correlated with figure recall.Meanwhile,ALT（r=0.765,P=0.002） and AST（r=0.602,P=0.029） were related to the subtest of list learning.BUN（r=-0.561,P=0.046） and uric acid（r=-0.608,P=0.036） had negative correlation with list recognition,and creatinine was negatively correlated with digit span subtest（r=-0.557,P=0.048） and delayed memory domain（r=-0.684,P=0.010）.Conclusion The cognitive function of patients with liver cirrhosis caused by chronic hepatitis B may be related to their renal function but not directly related to blood ammonia or hepatic function grade.

关 键 词：肝硬化 乙型肝炎 认知功能 RBANS 可重复性成套神经心理状态测验 血氨 肾功能 

分 类 号：R575.2[医药卫生—消化系统] R749.23[医药卫生—内科学]