口服谷氨酰胺挑战可改善肝硬化患者用于诊断轻微肝性脑病的心理测试表现。

Oral glutamine challenge improves the performance of psychometric tests for the diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis.

机构信息

"Gr. T. Popa" University of Medicine and Pharmacy Iasi, Romania; Email:

出版信息

J Gastrointestin Liver Dis. 2013 Sep;22(3):277-81.

Abstract

BACKGROUND & AIMS: Minimal hepatic encephalopathy is difficult to diagnose due to the lack of a gold standard test. Oral glutamine challenge has been found to increase blood ammonia in cirrhosis leading to secondary cognitive impairment. The aim of this study was to evaluate the value of oral glutamine challenge in improving the psychometric performance for the diagnosis of minimal hepatic encephalopathy, and the risk of this condition for overt hepatic encephalopathy in cirrhotic patients.

METHODS

Fifty-four cirrhotics (34 males; mean age 55.2 years) and 16 healthy controls were included. Minimal hepatic encephalopathy was assessed by the psychometric hepatic encephalopathy score. Arterial ammonia concentrations and psychometric tests were evaluated 60 minutes before and after a 20 g oral glutamine load. Follow-up lasted 12 months.

RESULTS

At baseline, 29 (53.7%) of 54 patients had minimal hepatic encephalopathy and significantly more (79.63%) post-glutamine (p<0.0001). Baseline arterial ammonia levels significantly raised post-glutamine in cirrhotics (85.2+/-20.8μg/dL versus 159.82 +/- 66.01μg/dL, p<0.0001), while in controls they remained unchanged (p=0.064). For the diagnosis of minimal hepatic encephalopathy, baseline arterial blood ammonia showed an area under the ROC curve of 0.54 (CI95%: 0.402-0.680, p=0.58), with no significant post-glutamine changes (0.53, CI95%: 0.389-0.667, p=0.77). Ten patients (18.51%) developed overt hepatic encephalopathy, among which 9 had minimal hepatic encephalopathy (4 at baseline, 5 post-glutamine). At multivariate analysis, MELD score (1.5187, CI95%: 1.0690-2.1574, p=0.0197) was an independent predictor of the overt hepatic encephalopathy.

CONCLUSIONS

In cirrhotic patients, an oral glutamine load improves the psychometric diagnostic performance for minimal hepatic encephalopathy. MELD score has been independently related to overt hepatic encephalopathy.

摘要

背景与目的

由于缺乏金标准测试，轻微肝性脑病的诊断较为困难。口服谷氨酰胺刺激已被发现可导致肝硬化患者血氨升高，进而导致继发性认知障碍。本研究旨在评估口服谷氨酰胺刺激在改善轻微肝性脑病诊断的心理计量学表现方面的价值，以及这种情况对肝硬化患者显性肝性脑病的风险。

方法

纳入 54 例肝硬化患者（34 名男性；平均年龄 55.2 岁）和 16 名健康对照者。通过心理计量肝性脑病评分评估轻微肝性脑病。在口服 20g 谷氨酰胺负荷前 60 分钟和后 60 分钟评估动脉氨浓度和心理计量测试。随访持续 12 个月。

结果

基线时，54 例患者中有 29 例（53.7%）患有轻微肝性脑病，口服谷氨酰胺后明显更多（79.63%）（p<0.0001）。肝硬化患者的基线动脉氨水平在口服谷氨酰胺后显著升高（85.2+/-20.8μg/dL 与 159.82 +/- 66.01μg/dL，p<0.0001），而对照组则保持不变（p=0.064）。对于轻微肝性脑病的诊断，基线动脉血氨的 ROC 曲线下面积为 0.54（95%CI：0.402-0.680，p=0.58），口服谷氨酰胺后无显著变化（0.53，95%CI：0.389-0.667，p=0.77）。10 例患者（18.51%）发生显性肝性脑病，其中 9 例患有轻微肝性脑病（4 例基线，5 例口服谷氨酰胺后）。多变量分析显示，MELD 评分（1.5187，95%CI：1.0690-2.1574，p=0.0197）是显性肝性脑病的独立预测因子。