轻微型老年肝性脑病患者血氨、脑血流动力学指标变化情况及对认知功能的影响  

Changes of blood ammonia and cerebral hemodynamic indexes in elderly patients with mild hepatic encephalopathy and their effects on cognitive function

作　　者：秦军胜 王洪亮[2] QIN Junsheng;WANG Hongliang(Department of Gastroenterology,Xi′an Fengcheng Hospital,Xi′an,Shaanxi 710021,China;School of Basic Medicine,Xi′an Jiaotong University,Xi′an,Shaanxi 710000,China)

机构地区：[1]西安凤城医院消化内科,陕西西安710021 [2]西安交通大学基础医学院,陕西西安710000

出　　处：《检验医学与临床》2022年第6期730-733,共4页Laboratory Medicine and Clinic

基　　金：国家自然科学基金面上项目(81871662)。

摘　　要：目的观察轻微型老年肝性脑病患者血氨、脑血流动力学指标及认知功能的变化情况,分析血氨、脑血流动力学指标对认知功能的影响。方法选取2017年1月至2019年1月西安凤城医院收治的63例轻微型老年肝性脑病患者作为肝性脑病组,另选取同期63例健康人群作为对照组。对肝性脑病组和对照组进行血氨、肝功能指标、脑血流动力学指标检测及认知功能评估。分析对照组和肝性脑病组血氨、肝功能指标、脑血流动力学指标、认知功能评分的差异,并分析血氨、脑血流动力学指标水平与认知功能评分之间的相关性。结果肝性脑病组血氨、总胆红素、丙氨酸氨基转移酶、清蛋白水平均高于对照组,差异均有统计学意义(P<0.05);肝性脑病组脑主动脉收缩期峰值速度(VP)、脑主动脉舒张末期峰值速度(VD)、脑动脉搏动指数(PI)均低于对照组,脑动脉阻力指数(RI)高于对照组,差异均有统计学意义(P<0.05);肝性脑病组韦氏成人认知功能评测量表(WAIS)评分(包括语言认知、操作认知、智商体现及WAIS总评分)均低于对照组,差异均有统计学意义(P<0.05)。血氨水平与WAIS评分呈负相关(r=-0.584,P<0.05);脑血流动力学指标水平与WAIS评分均存在相关性,其中VP、VD、PI水平与WAIS评分均呈正相关(r=0.613、0.743、0.684,P<0.05),RI水平与WAIS评分呈负相关(r=-0.826,P<0.05)。结论轻微型老年肝性脑病患者存在血氨水平升高、脑血流速度减慢、脑血流阻力提升、认知功能障碍等,且血氨水平异常、脑血流动力学指标水平异常与认知功能障碍之间均密切相关。Objective To observe the changes of blood ammonia,cerebral hemodynamic indexes and cognitive function in elderly patients with mild hepatic encephalopathy,and to analyze the effects of blood ammonia and cerebral hemodynamic indexes on cognitive function.Methods A total of 63 elderly patients with mild hepatic encephalopathy who were admitted to Xi′an Fengcheng Hospital from January 2017 to January 2019 were selected as the hepatic encephalopathy group.Another 63 healthy people were selected as the control group during the same period.Blood ammonia,liver function indexes,cerebral hemodynamic indexes and cognitive function evaluation were performed in the hepatic encephalopathy group and the control group.The differences of blood ammonia,liver function indexes,cerebral hemodynamic indexes and cognitive function score between the control group and hepatic encephalopathy group were analyzed,and the correlation between blood ammonia,cerebral hemodynamic indexes levels and cognitive function score was analyzed.Results The levels of blood ammonia,total bilirubin,alanine aminotransferase and albumin in the hepatic encephalopathy group were higher than those in the control group,and the differences were statistically significant(P<0.05).The cerebral aortic peak systolic velocity(VP),cerebral aortic peak end-diastolic velocity(VD),and cerebral artery pulsatility index(PI)in the hepatic encephalopathy group were lower than those in the control group,and the cerebral artery resistance index(RI)was higher than that in the control group,the differences were statistically significant(P<0.05).The Wechsler Adult Intelligence Scale(WAIS)scores(including language cognition,operational cognition,IQ performance and WAIS total score)in the hepatic encephalopathy group were lower than those in the control group,the differences were statistically significant(P<0.05).Blood ammonia level was negatively correlated with WAIS score(r=-0.584,P<0.05).There were correlations between cerebral hemodynamic indexes levels and WAIS score,among whi

关 键 词：轻微型肝性脑病 血氨 老年 脑血流动力学 认知功能 

分 类 号：R747.9[医药卫生—神经病学与精神病学]