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  

Value of Stroop Smartphone App in screening minimal hepatic encephalopathy

作　　者：王黎[1] 朱璇[1] 李洁[1] 张丽[1] 赵江明[1] 

机构地区：[1]安徽医科大学附属省立医院神经内科,合肥230001

出　　处：《中华神经医学杂志》2017年第7期711-714,共4页Chinese Journal of Neuromedicine

基　　金：安徽省科技攻关计划项目（1401045019）

摘　　要：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。Objective To assess the value of Stroop smartphone application （EncephalApp-Stroop） in screening minimal hepatic encephalopathy （MHE）. Methods Ninety hepatitis B cirrhotic patients without overt hepatic encephalopathy （OHE）, admitted to our hospital from January 2015 to February 2016, and other 90 healthy volunteers were chosen in our study. Psychometric hepatic encephalopathy scale （PHES） and EncephalApp-Stroop were performed. Normal reference value formulas were established based on the 5 psychometric tests at PHES in healthy controls. EncephalApp-Stroop contained ＂off＇ state （neutral stimuli） and ＂on＂ state （incongruent stimuli）. The time of completing five correct runs and the number of runs in ＂on＂ and ＂off＇ states were calculated. PHES was used to diagnose MHE as gold standard to compare the results of OHE patients and healthy subjects and the results of patients with/without MHE. EncephalApp-Stroop results were compared with PHES results by receiver operator characteristic analysis. Results OHE patients had significantly longer time than healthy subjects in Stroop ＂on＂ and ＂off＇ states （P〈0.05）. Traditionally, the total scores of PHES below -4 were diagnosed as MHE, and all the 90 patients taking PHES as gold standard, 52 patients were diagnosed as MHE. The time at Stroop ＂on＂ and ＂off＇ states and the number of trials completing 5 correct runs were longer/larger in patients with MHE as compared with those in patients without MHE, with significant differences （P〈0.05）. The validation cohort of EncephalApp-Stroop showed 87% sensitivity and 79% specificity. Conclusion The EncephalApp-Stroop is a valid, short and reliable tool for screening MHE.

关 键 词：乙肝性肝硬化 轻微型肝性脑病 肝性脑病心理测试评分 斯特鲁谱测试 

分 类 号：R575.3[医药卫生—消化系统]