Gad Yahia Z, Zaher Ashraf A, Moussa Nasser H, El-desoky Abd-Elmohsen E, Al-Adarosy Hala A
Internal Medicine Department, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt.
Arab J Gastroenterol. 2011 Jun;12(2):58-61. doi: 10.1016/j.ajg.2011.04.002. Epub 2011 Jun 12.
Minimal hepatic encephalopathy (MHE) represents a part of the spectrum of hepatic encephalopathy (HE). It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt.
A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test (SDT) and number connection test (NCT) appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured.
A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level (p-value <0.001) and a bad self-reported driving history (p<0.05) in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade (p<0.001), hepatitis B virus (HBV)-related aetiology (p<0.001) and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients (p<0.05) when compared with the other Child-Pugh grades.
Our data revealed a high prevalence of MHE (47%) among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management.
轻微肝性脑病（MHE）是肝性脑病（HE）范围的一部分。它会对日常生活质量和功能能力产生深远影响，且可能进展为显性HE。本研究旨在筛查埃及尼罗河三角洲城市曼苏拉肝硬化司机中的MHE。
对174名病毒标志物血清学阳性且患有肝硬化的连续司机进行MHE筛查。在同一地点进行问卷调查、标准心理测量测试并获取充分知情同意。当符号数字试验（SDT）和数字连接试验（NCT）一项或两项异常时，做出MHE诊断。对诊断为MHE的患者进行贝克量表和简易精神状态检查表调查。过夜禁食后，采集静脉血样本，采用常规方法进行血液学检查和常规肝功能检查。同时测量动脉血氨。
在符合纳入标准的139名患者中，共有66名患者有MHE证据。与MHE阴性组相比，MHE阳性组除动脉血氨水平显著升高（p值<0.001）和自我报告的不良驾驶史（p<0.05）外，无显著差异。多因素逻辑回归显示，Child-Pugh分级晚期（p<0.001）、乙型肝炎病毒（HBV）相关病因（p<0.001）和吸烟是MHE的显著危险因素。与其他Child-Pugh分级相比，Child-Pugh C级患者中MHE明显更常见（p<0.05）。
我们的数据显示，埃及肝硬化司机中MHE的患病率很高（47%）。因此，建议在评估高危人群时，尤其是在门诊环境中，纳入驾驶史以及定期进行纸笔标准心理测量测试，以便早期发现和妥善管理。
