Liver Research Laboratories, Pomeranian Medical University, Szczecin, Poland.
Liver Int. 2013 Oct;33(9):1332-40. doi: 10.1111/liv.12194. Epub 2013 May 8.
The psychometric hepatic encephalopathy score (PHES) is recommended as a gold standard in evaluation of minimal hepatic encephalopathy (HE). Normative databases have been collected in few countries, clearly showing differences among studied groups. Thus, the standardization of PHES for selected populations remains necessary.
To standardize PHES in a large cohort of Polish healthy subjects and to evaluate the normograms in patients with cirrhosis with quantified electroencephalography (EEG).
Three hundred and sixteen (142 males/174 females, aged 44.5 ± 12.1) normal individuals and 50 (31 males/19 females, aged 52.8 ± 12.4) patients with cirrhosis without overt HE were included. Key correction variables of psychometric tests were performed. The multivariate linear regression was used to calculate PHES normograms.
Age and education levels were identified as predictors of all tests, therefore age- and education-adjusted normograms were developed. A weighted time-errors regression model for line tracing test (LTT) scoring was used. The PHES ranged between +5 and -15 points and the cut-off between normal and pathological PHES was set on ≤-5 points. By this cut-off level, PHES had a sensitivity of 57% and specificity of 97% to diagnose minimal HE (AUC = 0.866 ± 0.028). In patients with cirrhosis, PHES correlated with severity of liver disease (MELD, r = -0.475, P < 0.001 and Child-Pugh classification, r = -0.452, P < 0.002) and EEG (r = 0.547, P < 0.002). In patients with impaired EEG, PHES was lower than in individuals with unaltered EEG (P < 0.02); however, agreement between these two modalities was limited.
Valid Polish PHES normograms, which incorporates w-LTT scoring system have been developed. Future multi-centre international studies are needed to validate widely applicable norms.
精神状态肝性脑病评分（PHES）被推荐为评估轻微肝性脑病（HE）的金标准。在少数国家已经收集了规范数据库，这些数据库清楚地显示了研究组之间的差异。因此，有必要为选定的人群制定 PHES 标准。
在波兰的一个大的健康受试者队列中对 PHES 进行标准化，并使用量化脑电图（EEG）评估肝硬化患者的 PHES 正常值。
纳入 316 名（142 名男性/174 名女性，年龄 44.5±12.1）正常个体和 50 名（31 名男性/19 名女性，年龄 52.8±12.4）无显性 HE 的肝硬化患者。对心理测试的关键校正变量进行了分析。使用多元线性回归计算 PHES 正常值图。
年龄和教育水平被确定为所有测试的预测因素，因此制定了年龄和教育调整的正常值图。使用线追踪测试（LTT）评分的加权时间错误回归模型。PHES 范围在+5 到-15 分之间，正常和病理 PHES 的分界点设定为≤-5 分。在该截断水平下，PHES 诊断轻微 HE 的灵敏度为 57%，特异性为 97%（AUC=0.866±0.028）。在肝硬化患者中，PHES 与肝病严重程度（MELD，r=-0.475，P<0.001 和 Child-Pugh 分级，r=-0.452，P<0.002）和 EEG（r=0.547，P<0.002）相关。在 EEG 受损的患者中，PHES 低于 EEG 正常的患者（P<0.02）；然而，这两种方法之间的一致性有限。
制定了包含 w-LTT 评分系统的有效的波兰 PHES 正常值图。未来需要进行多中心国际研究，以验证广泛适用的正常值。
