Das A, Dhiman R K, Saraswat V A, Verma M, Naik S R
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Gastroenterol Hepatol. 2001 May;16(5):531-5. doi: 10.1046/j.1440-1746.2001.02487.x.
The natural history of subclinical hepatic encephalopathy (SHE) is unknown. The present study was conducted to study the prevalence and the natural history of SHE in patients with cirrhosis of the liver.
One hundred and sixty-five patients with cirrhosis of the liver were studied. A total of nine psychometric tests (trail making and Wechsler adult intelligence scale-performance (WAIS-P) tests) were administered. Subclinical hepatic encephalopathy was present if two or more psychometric tests were abnormal. Seventy-two patients (SHE 40, without SHE 32) also underwent serial psychometric testing on follow-up visits at 6-8 week intervals.
Subclinical hepatic encephalopathy was present in 103 (62.4%) patients. The number and figure connection, block design and picture completion tests were the most useful in the detection of SHE. Severity of SHE, as assessed by the number of abnormal tests, was greater in patients with more severe liver disease. During follow up, SHE tended to persist or worsen in patients with poorer liver function. Although other clinical complications were similar in different groups, overt hepatic encephalopathy developed more commonly in those patients who had SHE at entry compared to those who did not (22.6 vs 5.6%, P = 0.044). Among the patients with SHE, the development of overt hepatic encephalopathy was more common in patients with Child's score of > 6 than with Child's score of <or= 6 (40 vs 5%, P = 0.019).
We conclude that SHE is common in cirrhosis. The natural history of SHE is worse in patients with advanced cirrhosis and SHE probably predisposes the cirrhotic patient to overt hepatic encephalopathy.
亚临床肝性脑病（SHE）的自然病程尚不清楚。本研究旨在探讨肝硬化患者中SHE的患病率及自然病程。
对165例肝硬化患者进行研究。共进行了9项心理测量测试（连线试验和韦氏成人智力量表操作部分（WAIS-P）测试）。如果两项或更多心理测量测试异常，则存在亚临床肝性脑病。72例患者（SHE患者40例，无SHE患者32例）在随访期间还每隔6 - 8周进行了系列心理测量测试。
103例（62.4%）患者存在亚临床肝性脑病。数字与图形连接、积木图案和图片填充测试在检测SHE方面最有用。根据异常测试的数量评估，SHE的严重程度在肝病更严重的患者中更高。在随访期间，肝功能较差的患者中SHE倾向于持续存在或恶化。尽管不同组的其他临床并发症相似，但与入院时无SHE的患者相比，入院时患有SHE的患者更常发生显性肝性脑病（22.6%对5.6%，P = 0.044）。在患有SHE的患者中，Child评分>6分的患者比Child评分≤6分的患者更常发生显性肝性脑病（40%对5%，P = 0.019）。
我们得出结论，SHE在肝硬化患者中很常见。晚期肝硬化患者中SHE的自然病程更差，并且SHE可能使肝硬化患者易患显性肝性脑病。
