通过测量肝硬度和肝静脉压力梯度诊断肝硬化患者的轻微肝性脑病。
Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient.
机构信息
Department of Hepatology, Institute of Liver and Biliary Science, New Delhi, India.
出版信息
Saudi J Gastroenterol. 2012 Sep-Oct;18(5):316-21. doi: 10.4103/1319-3767.101126.
BACKGROUND/AIM: Transient elastography (TE) of liver and hepatic venous pressure gradient (HVPG) allows accurate prediction of cirrhosis and its complications in patients with chronic liver disease. There is no study on prediction of minimal hepatic encephalopathy (MHE) using TE and HVPG in patients with cirrhosis.
PATIENTS AND METHODS
Consecutive cirrhotic patients who never had an episode of hepatic encephalopathy (HE) were enrolled. All patients were assessed by psychometry (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), critical flicker frequency test (CFF), TE by FibroScan and HVPG. MHE was diagnosed if there were two or more abnormal psychometry tests (± 2 SD controls).
RESULTS
150 patients with cirrhosis who underwent HVPG were screened; 91 patients (61%, age 44.0 ± 11.4 years, M:F:75:16, Child's A:B:C 18:54:19) met the inclusion criteria. Fifty three (58%) patients had MHE (Child A (7/18, 39%), Child B (32/54, 59%) and Child C (14/19, 74%)). There was no significant difference between alanine aminotranferease (ALT), aspartate aminotransferase (AST) and total bilirubin level in patients with MHE versus non MHE. Patients with MHE had significantly lower CFF than non MHE patients (38.4 ± 3.0 vs. 40.2 ± 2.2 Hz, P = 0.002). TE and HVPG in patients with MHE did not significantly differ from patients with no MHE (30.9 ± 17.2 vs. 29.8 ± 18.2 KPas, P = 0.78; and 13.6 ± 2.7 vs. 13.6 ± 3.2 mmHg, P = 0.90, respectively).There was significant correlation of TE with Child's score (0.25, P = 0.01), MELD (0.40, P = 0.001) and HVPG (0.72, P = 0.001) while no correlation with psychometric tests, CFF and MHE.
CONCLUSION
TE by FibroScan and HVPG cannot predict minimal hepatic encephalopathy in patients with cirrhosis.
背景/目的：肝脏瞬时弹性成像（TE）和肝静脉压力梯度（HVPG）可准确预测慢性肝病患者的肝硬化及其并发症。目前尚无关于使用 TE 和 HVPG 预测肝硬化患者微小肝性脑病（MHE）的研究。
患者与方法
连续纳入从未发生过肝性脑病（HE）的肝硬化患者。所有患者均接受心理测试（数字连接测试 A 和 B（NCT-A 和 B）、数字符号测试（DST）、序列点测试（SDT）、线追踪测试（LTT））、临界闪烁频率测试（CFF）、FibroScan 行 TE 和 HVPG 检测。如果有两个或两个以上的心理测试异常（± 2 SD 对照），则诊断为 MHE。
结果
对 150 例 HVPG 肝硬化患者进行了筛查；91 例（61%，年龄 44.0±11.4 岁，M:F:75:16，Child's A:B:C 18:54:19）符合纳入标准。53 例（58%）患者存在 MHE（Child A（7/18，39%）、Child B（32/54，59%）和 Child C（14/19，74%））。MHE 患者与非 MHE 患者的丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素水平无显著差异。MHE 患者的 CFF 明显低于非 MHE 患者（38.4±3.0 与 40.2±2.2 Hz，P=0.002）。MHE 患者的 TE 和 HVPG 与无 MHE 患者无显著差异（30.9±17.2 与 29.8±18.2 KPas，P=0.78；13.6±2.7 与 13.6±3.2 mmHg，P=0.90）。TE 与 Child 评分（0.25，P=0.01）、MELD（0.40，P=0.001）和 HVPG（0.72，P=0.001）呈显著相关，与心理测试、CFF 和 MHE 无相关性。
结论
FibroScan 行 TE 和 HVPG 不能预测肝硬化患者的微小肝性脑病。
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