Senzolo M, Amodio P, D'Aloiso M C, Fagiuoli S, Del Piccolo F, Canova D, Masier A, Bassanello M, Zanus G, Burra P
Gastroenterology, Department of Surgical and Gastroenterological Sciences, University-Hospital of Padua, Italy.
Transplant Proc. 2005 Mar;37(2):1104-7. doi: 10.1016/j.transproceed.2004.12.265.
Cirrhotic patients without overt hepatic encephalopathy may have cerebral function alterations called minimal hepatic encephalopathy (MHE). Our goal was to evaluate the role of partial pressure of ammonia (pNH3), neuropsychological, and neurophysiological assessment in detecting cognitive changes in cirrhotic patients awaiting liver transplantation.
Fourteen cirrhotic patients listed for liver transplant were studied. All patients underwent the neuropsychological battery called PSE. Neurophysiological assessment including spectral EEG (sEEG), evoked potential P300 and pNH3 and venous and arterial ammonia levels was performed in all patients. Four patients were transplanted.
Liver disease etiology was alcoholic in four patients, viral in six mixed in two, and cryptogenic in two. PSE scores revealed MHE in 8 patients; sEEG was altered in 6, and P300 in 1. No correlations were detected between P300, sEEG, and PSE. pNH3 and arterial ammonia levels were significantly higher in the subgroup of patients with altered sEEG and were correlated with theta band increase in sEEG but not with pathological PSE scores or P300 wave abnormalities.
The combination of sEEG and PSE, and possibly also pNH3 and arterial ammonia, is useful in detecting cerebral function alterations in cirrhotic patients with no apparent encephalopathy, whereas P300 is not. The diagnosis of MHE obtained using the multimodal approach adopted in this study may enable the adequate treatment of these patients prior to surgery, which includes advising them not to drive and adjusting their priority on the waiting list for OLTx in the light of a condition that cannot be evaluated by Child Pugh score and MELD score.
没有明显肝性脑病的肝硬化患者可能存在称为轻微肝性脑病（MHE）的脑功能改变。我们的目标是评估氨分压（pNH3）、神经心理学和神经生理学评估在检测等待肝移植的肝硬化患者认知变化中的作用。
对14名列入肝移植名单的肝硬化患者进行了研究。所有患者均接受了名为PSE的神经心理学测试。对所有患者进行了神经生理学评估，包括频谱脑电图（sEEG）、诱发电位P300以及pNH3和静脉血与动脉血氨水平测定。4名患者接受了移植。
4名患者的肝病病因是酒精性的，6名是病毒性的，2名是混合型的，2名是隐源性的。PSE评分显示8名患者存在MHE；6名患者的sEEG有改变，1名患者的P300有改变。未检测到P300、sEEG与PSE之间的相关性。sEEG改变的患者亚组中pNH3和动脉血氨水平显著更高，且与sEEG中θ波增加相关，但与病理性PSE评分或P300波异常无关。
sEEG和PSE的联合应用，可能还有pNH3和动脉血氨，有助于检测无明显脑病的肝硬化患者的脑功能改变，而P300则不然。采用本研究中多模式方法获得的MHE诊断可能使这些患者在手术前得到适当治疗，包括建议他们不要开车，并根据Child Pugh评分和MELD评分无法评估的病情调整他们在肝移植等待名单上的优先级。
