Hourmand-Ollivier Isabelle, Piquet Marie-Astrid, Toudic Jean Pierre, Denise Pierre, Dao Thông
Department of Nutrition and Hepatogastroenterology, CHU Cote de Nacre, 14033 Caen cedex, France.
World J Gastroenterol. 2006 Apr 14;12(14):2243-4. doi: 10.3748/wjg.v12.i14.2243.
To assess the actigraphy, an ambulatory and continuous monitoring of wrist motor activity fitted to study sleep/wake patterns in hepatic encephalopathy (HE).
Twenty-five cirrhotic patients (17 M, 8 F, mean age 56+/-11 years, 24/25 alcoholic, Child-Pugh A , B, C: 2, 6, 17) were included. The patients were classified into 3 groups: stage 0 group (n = 12), stage 1-2 group (n = 6), and stage 3-4 group (n = 7) of encephalopathy. Over three consecutive days, patients had clinical evaluation 3 times a day with psychometric test, venous ammoniemia, flash visually evoked potentials (VEP), electroencephalogram and continuous actigraphic monitoring for 3 d, providing 5 parameters: mesor, amplitude, acrophase, mean duration of activity (MDAI) and inactivity (MDII) intervals.
Serum ammonia and VEP did not differ among the 3 groups. Electroencephalography mean dominant frequency (MDF) correlated significantly with clinical stages of HE (r = 0.65, P = 0.003). The best correlation with HE stage was provided by actigraphy especially with MDAI (r = 0.7, P < 10(-4)) and mesor (r = 0.65, P < 10(-4)). MDAI correlated significantly with MDF (r = 0.62, 0.004) and was significantly shorter in case of HE compared to patients without HE (stage 0: 5.33+/-1.6 min; stage 1-2: 3.28+/-1.4 min; stage 3-4: 2.52+/-1.1 min; P < 0.05). Using a threshold of MDAI of less than 4.9 min, sensitivity, specificity, positive predictive value, negative predictive value for HE diagnosis were 85%, 67%, 73% and 80%, respectively.
Actigraphy may be an objective method to identify HE, especially for early HE detection. Motor activity at the wrist correlates well with clinical stages of HE. MDAI and mesor are the most relevant parameters.
评估活动记录仪，一种用于研究肝性脑病（HE）睡眠/觉醒模式的可穿戴式连续手腕运动活动监测设备。
纳入25例肝硬化患者（17例男性，8例女性，平均年龄56±11岁，24/25例为酒精性肝硬化，Child-Pugh A、B、C级分别为2例、6例、17例）。将患者分为3组：脑病0期组（n = 12）、1 - 2期组（n = 6）和3 - 4期组（n = 7）。连续三天，患者每天进行3次临床评估，包括心理测试、静脉血氨测定、闪光视觉诱发电位（VEP）、脑电图检查以及连续3天的活动记录仪监测，提供5个参数：中值、振幅、峰值相位、平均活动持续时间（MDAI）和平均静止持续时间（MDII）。
3组患者的血清氨和VEP无差异。脑电图平均优势频率（MDF）与HE临床分期显著相关（r = 0.65，P = 0.003）。活动记录仪与HE分期的相关性最佳，尤其是与MDAI（r = 0.7，P < 10⁻⁴）和中值（r = 0.65，P < 10⁻⁴）。MDAI与MDF显著相关（r = 0.62，P = 0.004），与无HE患者相比，HE患者的MDAI明显缩短（0期：5.33±1.6分钟；1 - 2期：3.28±1.4分钟；3 - 4期：2.52±1.1分钟；P < 0.05）。以MDAI小于4.9分钟为阈值，HE诊断的敏感性、特异性、阳性预测值、阴性预测值分别为85%、67%、73%和80%。
活动记录仪可能是识别HE的一种客观方法，尤其适用于早期HE检测。手腕部的运动活动与HE临床分期密切相关。MDAI和中值是最相关的参数。
