数字连接试验-B联合轨迹描绘试验对轻微肝性脑病诊断价值的前瞻性、多中心、真实世界研究  

A prospective multicenter and real-world study on the diagnostic value of combination of number connection test-B and line tracing test in mild hepatic encephalopathy

作　　者：闫俊卿[1] 祖红梅 王晶[3] 郭小青[4] 李晓燕 刘尚豪 向慧玲[1] 严兆兰 党彤[3] 王海英 孙佳 黄磊 孟繁平 张清格[7] 张国[8] 黄燕[9] 杨少奇[10] 呼圣娟[11] 阮继刚 李异玲[13] 雷创[14] 宋瑛 瞿章书 石瑞春 刘琴 刘益军[19] 杨巧华 赵学兰 赵彩彦[22] 吴晨曦 沈迁 武曼群[25] 刘娅媛[26] 鄢冬梅 刘川 福军亮 祁小龙 Yan Junqing;Zu Hongmei;Wang Jing;Guo Xiaoqing;Li Xiaoyan;Liu Shanghao;Xiang Huiling;Yan Zhaolan;Dang Tong;Wang Haiying;Sun Jia;Huang Lei;Meng Fanping;Zhang Qingge;Zhang Guo;Huang Yan;Yang Shaoqi;Hu Shengjuan;Ruan Jigang;Li Yiling;Lei Chuang;Song Ying;Qu Zhangshu;Shi Ruichun;Liu Qin;Liu Yijun;Yang Qiaohua;Zhao Xuelan;Zhao Caiyan;Wu Chenxi;Shen Qian;Wu Manqun;Liu Yayuan;Yan Dongmei;Liu Chuan;Fu Junliang;Qi Xiaolong(Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Gastroenterology,the Fourth People's Hospital of Qinghai Province,Xining 810099,China;Department of Gastroenterology,the Second Affiliated Hospital of Baotou Medical College,Baotou 014030,China;Department of Hepatology,the Third People's Hospital of Taiyuan,Taiyuan 030012,China;National Clinical Research Center for Infectious Diseases,Senior Department of Infectious Diseases,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;the First School of Clinical Medicine of Lanzhou University,Lanzhou 730030,China;Department of Hepatology,Xingtai People's Hospital,Xingtai 054001,China;Department of Gastroenterology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Infectious Diseases,Hunan Key Laboratory of Viral Hepatitis,Xiangya Hospital of Central South University,Changsha 410008,China;Department of Gastroenterology,General Hospital of Ningxia Medical University,Yinchuan 750003,China;Department of Gastroenterology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Gastroenterology,Branch Hospital for Diseases of Heart,Brain,and Blood Vessels of General Hospital of Ningxia Medical University,Yinchuan 750002,China;Department of Gastroenterology,the First Hospital of China Medical University,Shenyang 110001,China;Department of Infectious Dieseas

机构地区：[1]天津市第三中心医院消化肝病科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,天津300170 [2]青海省第四人民医院消化内科,西宁8810099 [3]包头医学院第二附属医院消化内科,包头014030 [4]太原市第三人民医院肝病科,太原030012 [5]国家感染性疾病临床医学研究中心,解放军总医院第五医学中心感染病医学部,北京100039 [6]兰州大学第一临床医学院,兰州730030 [7]邢台市人民医院中西医结合肝病科,邢台054001 [8]广西壮族自治区人民医院消化内科,南宁530021 [9]中南大学湘雅医院感染病科,病毒性肝炎湖南省重点实验室,长沙410008 [10]宁夏医科大学总医院消化内科,银川750003 [11]宁夏回族自治区人民医院消化内科,银川750002 [12]宁夏医科大学总医院心脑血管病医院消化内科,银川750002 [13]中国医科大学附属第一医院消化内科,沈阳110001 [14]常德市第一人民医院感染科,常德415003 [15]西安高新医院消化内科,西安710075 [16]湘西自治州人民医院感染科,吉首416007 [17]吴忠市人民医院消化内科,吴忠751199 [18]贵州医科大学附属医院感染科,贵阳550004 [19]湖南中医药高等专科学校第一附属医院肝病科,株洲412008 [20]怀化市第一人民医院感染病中心肝病科,怀化418099 [21]重庆市公共卫生医疗救治中心肝病科,重庆400036 [22]河北医科大学第三医院感染科,石家庄050051 [23]益阳市第四人民医院感染科,益阳413000 [24]银川市第二人民医院消化内科,银川750011 [25]银川市第一人民医院消化内科,银川1750010 [26]丹东市中心医院消化内科,丹东118002 [27]沈阳七三九医院肝病科,沈阳110034 [28]东南大学附属中大医院放射科门静脉高压中心,南京210009

出　　处：《中华消化杂志》2022年第10期659-666,共8页Chinese Journal of Digestion

基　　金：天津市卫生健康科技项目(TJWJ2022XK029);天津市医学重点学科(专科)建设项目(TJYXZDXK-034A);包头医学院科学研究基金项目(BYJJ-QWB202217)。

摘　　要：目的探讨肝性脑病心理学评分(PHES)子测试单独和联合检测对肝硬化患者轻微肝性脑病(MHE)的诊断价值,进而优化PHES。方法本研究为前瞻性、多中心、真实世界研究,由国家感染性疾病临床医学研究中心和中国门静脉高压联盟发起,参与单位来自全国13个省(自治区、直辖市)的26家医院,包括天津市第三中心医院、青海省第四人民医院、包头医学院第二附属医院、太原市第三人民医院和解放军总医院第五医学中心等。连续纳入2021年10月至2022年2月门诊和住院无显性肝性脑病的肝硬化患者。所有患者均以相同顺序接受数字连接试验(NCT)-A、NCT-B、数字符号试验(DST)、轨迹描绘试验(LTT)、系列打点试验(SDT)共5项PHES子测试,并计算分值。以PHES总分<-4分作为诊断MHE的界值。比较MHE组与非MHE组子测试得分。绘制受试者操作特征曲线,以曲线下面积(AUC)评估PHES各子测试单独、2项联合、3项联合检测对MHE的诊断价值。统计学方法采用Mann-Whitney U检验和DeLong检验。结果共纳入581例肝硬化患者,457例诊断为MHE,MHE患病率为78.7%。MHE组NCT-A、NCT-B、SDT、LTT、DST测试结果分别为60.00 s(47.01 s,88.00 s)、90.45 s(69.32 s,125.35 s)、74.00 s(57.65 s,96.60 s)、74.72分(60.00分,98.61分)和27.00分(20.00分,36.00分),与非MHE组的34.00 s(29.15 s,44.48 s)、50.00 s(40.98 s,60.77 s)、50.00 s(41.07 s,63.03 s)、46.23分(38.55分,59.42分)和42.00分(34.00分,50.75分)相比差异均有统计学意义(Z=12.37、12.98、9.83、11.56、10.66,均P<0.001)。PHES单项子测试NCT-B、NCT-A、LTT、DST和SDT诊断MHE的AUC(95%置信区间)分别为0.880(0.849~0.910)、0.862(0.828~0.896)、0.838(0.799~0.877)、0.812(0.772~0.851)和0.788(0.743~0.832)。子测试两两组合显著提高了对MHE的诊断效能,其中NCT-B+LTT诊断效能最优,AUC(95%置信区间)为0.924(0.902~0.947),特异度为91.9%,灵敏度为79.2%,优于PHES单项子测试(NCT-A、NCT-B、SDT、LTT和DObjective To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score(PHES)in mild hepatic encephalopathy(MHE)of patients with liver cirrhosis,so as to optimize the PHES.Methods This was a prospective,multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium.Twenty-six hospitals from 13 provinces,autonomous regions and municipalities countrywide participated in this study,induding Tianjin Third Central Hospital,the Fourth People's Hospital of Qinghai Province,the Second Affiliated Hospital of Baotou Medical College,the Third People's Hospital of Taiyuan,the Fifth Medical Center of PLA General Hospital and so on.From October 2021 to February 2022,outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled.All patients received 5 PHES subjects in the same order:number connection test(NCT)-A,NCT-B,digit symbol test(DST),line tracing test(LTT)and serial dotting test(SDT),and the scores were calculated.The total score of PHES<-4 was taken as the cut-off value for diagnosing MHE.Compare the differences in each subtest between MHE group and non-MHE group.Receiver operating characteristic curve(ROC)and area under the curve(AUC)was performed to assess the diagnostic value of independent and combined subtests in MHE.Mann-Whitney U test and DeLong test were used for statistical analysis.Results A total of 581 patients with liver cirrhosis were enrolled,457 were diagnosed as MHE,and the incidence of MHE was 78.7%.The results of NCT-A,NCT-B,SDT,LTT,DST of MHE group were 60.00 s(47.01 s,88.00 s),90.45 s(69.32 s,125.35 s),74.00 s(57.65 s,96.60 s),74.72(60.00,98.61)and 27.00(20.00,36.00),respectively.Compared those of non-MHE group(34.00 s(29.15 s,44.48 s),50.00 s(40.98 s,60.77 s),50.00 s(41.07 s,63.03 s),46.23(38.55,59.42)and 42.00(34.00,50.75)),the differences were statistically significant(Z=12.37,12.98,9

关 键 词：肝硬化 轻微肝性脑病 肝性脑病心理学评分 数字连接试验-B 轨迹描绘试验 

分 类 号：R575.3[医药卫生—消化系统]