肝硬化合并轻微型肝性脑病的临床特点以及相关影响因素分析  

Clinical characteristics and relatedinfluencing factors of minimalhepatic encephalopathy in patients with liver cirrhosis

作　　者：唐艳芳[1] 刘旭东[1] 王文鑫 贾瑞 李晓燕 于峰 毕京峰 孟繁平 王福生 福军亮 TANG Yan-fang;LIU Xu-dong;WANG Wen-xin;JIA Rui;LI Xiao-yan;YU Feng;BI Jing-feng;MENG Fan-ping;WANG Fu-sheng;FU Jun-liang(Department of liver disease,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,China)

机构地区：[1]广西中医药大学附属瑞康医院肝病科,南宁530011 [2]解放军总医院第五医学中心感染病医学部,北京100039

出　　处：《传染病信息》2022年第4期316-320,共5页Infectious Disease Information

基　　金：国家自然科学基金面上项目(81572462);国家自然科学基金创新群体项目(81721002);北京市卫计委首都卫生发展科研专项(2016-2-5031);广西中医药大学“歧黄工程”高层次人才团队培育项目(中西医结合防治肝病创新团队)[桂中医大人(2021)10号]。

摘　　要：目的 观察肝硬化合并轻微型肝性脑病(minimal hepatic encephalopathy, MHE)的临床特点,以及相关临床指标与MHE发生风险的关系。方法 选取87例肝硬化患者,每例患者均进行数字连接试验-A(number connection test-A,NCT-A)测试,测试结果超过正常值上限的患者确定为MHE组,否则为非MHE组。同时收集患者病史及血常规、肝功能、血氨、凝血功能等临床指标,并计算肝功能Child-Pugh评分,通过Logistic回归分析MHE发生的危险因素。结果 87例肝硬化患者中,49例(56.3%)NCT-A异常,诊断为MHE。统计学分析发现MHE组血氨水平明显高于非MHE组(P <0.05),但MHE组的血氨水平与NCT-A异常程度无明显相关性。MHE组中,失代偿期肝硬化患者比例、既往发生显性肝性脑病的患者比例、肝功能Child-Pugh评分B&C级患者比例显著高于非MHE组(P均<0.05);MHE组年龄偏低,具有更高的TBIL、氨基转移酶水平,而血ALB、CHE、PTA等较非MHE组均显著下降(P均<0.05)。单因素Logistic回归分析发现,年龄偏低、失代偿期肝硬化、Child-Pugh分级高、血氨水平高、CHE水平低、TBIL水平高、PTA降低均是MHE发生的危险因素(P均<0.05);多因素Logistic回归分析发现,TBIL水平高是判断MHE发生风险的独立预测因素。结论 肝硬化患者中MHE发生率较高,特别是肝硬化失代偿期患者和肝功能基础较差的患者发生MHE风险显著增加,总胆红素水平高是发生MHE的独立危险因素。Objective To identify the clinical characteristics of minimal hepatic encephalopathy(MHE) in patients with liver cirrhosis,and investigate the relationship between related clinical indicators and the risk of MHE. Methods A total of 87 patients with liver cirrhosis were enrolled and tested by Number Connection Test-A. Patients whose test results exceed the upper limit of normal values were classified as MHE group, while others werenon-MHE group. The medical history, blood routine examination, liver function, blood ammonia, coagulation function and related clinical indicators were collected, and Child-Pugh score was calculated. The risk factors of MHE were analyzed by Logistic regression. Results Among 87 patients with liver cirrhosis, 49(56.3%)with abnormal NCT-A were diagnosed with MHE. The blood ammonia level of MHE patients was significantly higher than that of non-MHE patients(P <0.05), however, there was no significant correlation between blood ammonia level and abnormal degree of NCT-A in MHE patients(P > 0.05). In MHE group, the proportion of patientswith decompensated cirrhosis, previous history of overt hepatic encephalopathy(OHE), and Child-Pugh class B or C were significantly higher than that in non-MHE group(P <0.05). Compared with non-MHE group, MHE patients had significantly higher levels of bilirubin and transaminase and lower levels of serum albumin, cholinesterase, prothrombin activity(P > 0.05). Univariate Logistic regression analysis showed that younger age, decompensated cirrhosis, high Child-Pugh grade, high blood ammonia level, low cholinesterase level, high total bilirubin level and decreased prothrombin activity were all risk factors for MHE. While in multivariate Logistic regression analysis, high total bilirubin was identified as independent predictors of MHE. Conclusions A higher incidence of MHE was observed in patients with liver cirrhosis, especially in patients with decompensated cirrhosisand poor liver function. The high level of total bilirubin is an independent risk factor for MHE

关 键 词：轻微型肝性肝病 肝硬化 数字连接试验-A 危险因素 总胆红素 肝功能 血氨 显性肝性脑病 

分 类 号：R575.2[医药卫生—消化系统]