抑制控制测试、临界闪烁频率和心理测试在肝硬化性轻微肝性脑病的诊断中的应用。
Inhibitory control test, critical flicker frequency, and psychometric tests in the diagnosis of minimal hepatic encephalopathy in cirrhosis.
机构信息
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
出版信息
Saudi J Gastroenterol. 2013 Jan-Feb;19(1):40-4. doi: 10.4103/1319-3767.105924.
BACKGROUND/AIM: Minimal hepatic encephalopathy (MHE) impairs health-related quality of life and driving ability of the patient.
OBJECTIVE
We assessed the utility of the inhibitory control test (ICT), critical flicker frequency (CFF), and psychometry in the diagnosis of MHE.
PATIENTS AND METHODS
Consecutive patients with cirrhosis underwent number connection tests A and B (NCT-A, B), digit symbol test (DST), line tracing test (LTT), serial dot test (SDT), CFF, and ICT at baseline and after four hours. Fifty healthy subjects served as controls for the ICT test.
RESULTS
Fifty patients with cirrhosis (43.4 ± 10.2 yrs, M: F 42:8) underwent psychometric tests [NCT-A (48.3 ± 17.7 vs. 42.6 ± 17.3 sec, P = 0.001), NCT-B (85.7 ± 40.1 vs. 90.2 ± 37.0 sec, P = 0.18), DST (23.5 ± 9.3 vs. 23.0 ± 8.7, P = 0.45), LTT (96.6 ± 48.2 vs. 96.8 ± 46.8 sec, P = 0.92), SDT (88.0 ± 39.5 vs. 83.4 ± 37.2 sec, P = 0.02)] at baseline and after four hours. Target accuracy of ICT was lower in patients with cirrhosis compared with controls (88.4 ± 5.6 vs. 95.6 ± 2.1, P = 0.01), whereas ICT lures were higher (18.3 ± 4.2 vs 10.2 ± 2.8, P = 0.01). Patients with cirrhosis showed a reduction in lures in the second evaluation compared with the first (18.3 ± 4.2 vs. 17.1 ± 4.3, P = 0.003) but no change in target accuracy (88.4 ± 5.6 vs. 88.4 ± 5.3, P = 0.97). Control subjects did not show any change either in lures (10.2 ± 2.8 vs. 10.3 ± 2.1, P = 0.65) or target accuracy (95.6 ± 2.1 vs. 95.5 ± 2.2, P = 0.82). The sensitivity and specificity of ICT test for the diagnosis of MHE at lure rate >16.5 was 88.5 and 56%, respectively. CFF in patients with MHE (38.4 ± 1.8 vs. 38.6 ± 1.5, P = 0.3) and non MHE (40.6 ± 2.2 vs. 40.8 ± 2.2, P = 0.6) did not show any difference after four hours as in controls (41.9 ± 2.4 vs. 42.1 ± 2.0, P = 0.3). Thirty one (31%) patients preferred psychometric tests, 57 (57%) preferred CFF and only 12 (12%) preferred ICT ( P = 0.001).
CONCLUSIONS
ICT, CFF, and psychometric tests are useful tools to assess MHE, and CFF was preferred by this study cohort.
背景/目的：轻微肝性脑病（MHE）会损害患者的健康相关生活质量和驾驶能力。
目的
我们评估了抑制控制测试（ICT）、临界闪烁频率（CFF）和心理计量学在 MHE 诊断中的应用。
患者和方法
连续的肝硬化患者在基线和四小时后接受数字连接测试 A 和 B（NCT-A、B）、数字符号测试（DST）、线追踪测试（LTT）、连续点测试（SDT）、CFF 和 ICT。50 名健康受试者作为 ICT 测试的对照组。
结果
50 名肝硬化患者（43.4 ± 10.2 岁，男性：女性 42:8）进行了心理计量学测试[NCT-A（48.3 ± 17.7 与 42.6 ± 17.3 秒，P = 0.001），NCT-B（85.7 ± 40.1 与 90.2 ± 37.0 秒，P = 0.18），DST（23.5 ± 9.3 与 23.0 ± 8.7 秒，P = 0.45），LTT（96.6 ± 48.2 与 96.8 ± 46.8 秒，P = 0.92），SDT（88.0 ± 39.5 与 83.4 ± 37.2 秒，P = 0.02）]在基线和四小时后。与对照组相比，肝硬化患者 ICT 的目标准确率较低（88.4 ± 5.6 与 95.6 ± 2.1，P = 0.01），而 ICT 诱饵较高（18.3 ± 4.2 与 10.2 ± 2.8，P = 0.01）。与第一次评估相比，肝硬化患者第二次评估的诱饵减少（18.3 ± 4.2 与 17.1 ± 4.3，P = 0.003），但目标准确率无变化（88.4 ± 5.6 与 88.4 ± 5.3，P = 0.97）。对照组的诱饵（10.2 ± 2.8 与 10.3 ± 2.1，P = 0.65）或目标准确率（95.6 ± 2.1 与 95.5 ± 2.2，P = 0.82）均无变化。在诱饵率>16.5%的情况下，ICT 测试对 MHE 的诊断的敏感性和特异性分别为 88.5%和 56%。MHE 患者（38.4 ± 1.8 与 38.6 ± 1.5，P = 0.3）和非 MHE 患者（40.6 ± 2.2 与 40.8 ± 2.2，P = 0.6）的 CFF 在四小时后与对照组（41.9 ± 2.4 与 42.1 ± 2.0，P = 0.3）均无差异。31%（31%）的患者更喜欢心理计量学测试，57%（57%）更喜欢 CFF，只有 12%（12%）更喜欢 ICT（P = 0.001）。
结论
ICT、CFF 和心理计量学测试是评估 MHE 的有用工具，而 CFF 是本研究队列的首选。
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