隐匿性肝性脑病常用诊断方法的比较研究  

Comparative study on common diagnostic methods for covert hepatic encephalopathy

作　　者：黄海英[1] 李素文[1] 许晓勇[1] 蔡轶[1] 许建明[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022

出　　处：《中华消化杂志》2016年第10期692-697,共6页Chinese Journal of Digestion

摘　　要：目的 评价临界闪烁频率（CFF）、肝性脑病心理学评分（PHES）和Stroop测验诊断隐匿性肝性脑病（CHE）的临床应用价值.方法 纳入110例肝硬化失代偿期患者和54例无肝病的对照者,以PHES＜-4分作为CHE的参考阈值,分析得出CFF和Stroop测验的测试时间诊断CHE的阈值.以PHES、CFF、Stroop测验中至少2项阳性作为诊断CHE的“金标准”,评价这3种方法诊断CHE的价值.统计学方法采用t检验和ROC曲线分析.结果 110例肝硬化患者中,无肝性脑病40例,CHE52例,2级肝性脑病18例.对照组CFF值和Stroop测验的总时间分别为（43.70±1.92） Hz和（201.17±20.65）s.无肝性脑病组CFF值为（41.40±1.85） Hz,高于CHE组的（38.33±2.32） Hz,差异有统计学意义（t=-7.116,P＜0.01）;无肝性脑病组Stroop测验的总时间为（197.91±26.68）s,短于CHE组的（253.24±33.33）s,差异有统计学意义（t=8.936,P＜0.01）.当以PHES＜-4分作为CHE的参考阈值时,CFF诊断CHE的阈值为39 Hz,敏感度为94.9％,特异度为73.1％,AUC值为0.879;Stroop测验的总时间诊断CHE的阈值为233.80 s,敏感度为83.3％,特异度为71.7％,AUC值为0.803.CHE组患者PHES 5项子测试中的数字连接试验（NCT）-A、NCT-B和数字符号试验（DST）的完成时间分别为（80.27±36.05）、（124.18±55.96）和（25.03±8.23）s,与无肝性脑病组的（56.68±18.82）、（80.00±25.58）和（34.68±8.75）s相比,差异均有统计学意义（t=3.691、4.108、-4.780,P均＜0.01）.与PHES和Stroop测验联合诊断无肝性脑病、CHE和2级肝性脑病的检测结果比较,以CFF值＜39 Hz作为检测阈值的一致率分别达95.0％、61.5％和100.0％.结论 PHES中的NCT-A、NCT-B和DST3个子测试检测CHE的效能较高.CFF和Stroop测验也是较为可靠的筛选鉴别CHE的方法,具有客观和特异性强的检测优势.Objective To evaluate clinical application value of critical flicker frequency （CFF）,psychometric hepatic encephalopathy score （PHES） and Stroop test in the diagnosis of covert hepatic encephalopathy （CHE）.Methods A total of 110 patients with decompensated liver cirrhosis and 54 individuals without liver diseases were enrolled as control group.According to PHES〈-4 points as reference threshold for CHE,the threshold of CFF and time of Stroop test for CHE diagnosis was caculated.Positive results of at least two of PHES,CFF and Stroop tests was considered as the gold standard for CHE diagnosis,and then the value of these three methods in CHE diagnosis was evaluated.Student＇s t test and receiver operating characteristic curve （ROC） were used for statistical analysis.Results Among the 110 patients with liver cirrhosis,40 patients had no hepatic encephalopathy （HE0）,52 patients had CHE,and 18 patients had grade 2 hepatic encephalopathy （HE2）.The CFF value and total time of Stroop test of control group were （43.70±1.92） Hz and （201.17±20.65） s,respectively.The CFF value of HE0 group was （41.40 ± 1.85） Hz,which was higher than that of CHE group （（38.33 ± 2.32） Hz）,and the difference was statistically significant （t=-7.116,P〈0.01）.The total time of Stroop test of HE0 group was （197.91±26.68） s,which was shorter than that of CHE group （（253.24± 33.33） s）,and the difference was statistically significant （t=8.936,P〈0.01）.When PHES〈-4 points was considered as a reference threshold of CHE,the threshold of CFF for CHE diagnosis was 39 Hz,the sensitivity was 94.9% and the specificity was 73.1%,the area under the curve （AUC） was 0.879.The threshold of the total time of Stroop test for CHE diagnosis was 233.80 s,the sensitivity was 83.3 % and the specificity was 71.1%,the AUC was 0.803.The completion time of the number connection test （NCT）-A,NCT-B and digit symbol test （DST）,which were there of five subtests of PHES,of CHE group were （80

关 键 词：肝硬化 肝性脑病 临界闪烁频率 心理学肝性脑病评分 斯特鲁普测验 

分 类 号：R575.3[医药卫生—消化系统]