Singh Jatinderpal, Sharma Barjesh Chander, Maharshi Sudhir, Puri Vinod, Srivastava Siddharth
Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
Department of Neurology, G. B. Pant Hospital, New Delhi, India.
J Gastroenterol Hepatol. 2016 Jun;31(6):1203-9. doi: 10.1111/jgh.13283.
Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy. Spectral electroencephalogram (sEEG) analysis improves the recognition of MHE by decreasing inter-operator variability and providing quantitative parameters of brain dysfunction. We compared sEEG in patients with cirrhosis with and without MHE and the effects of lactulose on sEEG in patients with MHE.
One hundred patients with cirrhosis (50 with and 50 without MHE) were enrolled. Diagnosis of MHE was based on psychometric hepatic encephalopathy score (PHES) of ≤ -5. Critical flicker frequency, model of end-stage liver disease score, and sEEG were performed at baseline in all patients. The spectral variables considered were the mean dominant frequency (MDF) and relative power in beta, alpha, theta, and delta bands. Patients with MHE were given 3 months of lactulose, and all parameters were repeated.
Spectral electroencephalogram analysis showed lower MDF (7.8 ± 1.7 vs 8.7 ± 1.3 Hz, P < 0.05) and higher theta relative power (34.29 ± 4.8 vs 24 ± 6.7%, P = 001) while lower alpha relative power (28.6 ± 4.0 vs 33.5 ± 5.3%, P = .001) in patients with MHE than in patients without MHE. With theta relative power, sensitivity 96%, specificity 84%, and accuracy of 90% were obtained for diagnosis of MHE. After lactulose treatment, MHE improved in 21 patients, and significant changes were seen in MDF (7.8 ± 0.5 vs 8.5 ± 0.6), theta (34.2 ± 4.8 vs 23.3 ± 4.1%), alpha (28.6 ± 4.0 vs 35.5 ± 4.5%), and delta relative power (13.7 ± 3.5 vs 17.0 ± 3.3%) after treatment (P ≤ 0.05).
Spectral EEG is a useful objective and quantitative tool for diagnosis and to assess the response to treatment in patients with cirrhosis with MHE.
轻微肝性脑病（MHE）是肝性脑病最轻微的形式。频谱脑电图（sEEG）分析通过减少操作者间的差异并提供脑功能障碍的定量参数，提高了对MHE的识别能力。我们比较了伴有和不伴有MHE的肝硬化患者的sEEG，以及乳果糖对MHE患者sEEG的影响。
纳入100例肝硬化患者（50例伴有MHE，50例不伴有MHE）。MHE的诊断基于心理测量肝性脑病评分（PHES）≤ -5。所有患者在基线时进行临界闪烁频率、终末期肝病模型评分和sEEG检查。所考虑的频谱变量为平均优势频率（MDF）以及β、α、θ和δ频段的相对功率。给予MHE患者3个月的乳果糖治疗，然后重复所有参数检查。
频谱脑电图分析显示，MHE患者的MDF较低（7.8±1.7 vs 8.7±1.3Hz，P<0.05），θ相对功率较高（34.29±4.8 vs 24±6.7%，P = 0.01），而α相对功率较低（28.6±4.0 vs 33.5±5.3%，P = 0.001）。以θ相对功率诊断MHE时，敏感性为96%；特异性为84%，准确性为90%。乳果糖治疗后，21例MHE患者病情改善，治疗后MDF（7.8±0.5 vs 8.5±0.6）、θ（34.2±4.8 vs 23.3±4.1%）、α（28.6±4.0 vs 35.5±4.5%）和δ相对功率（13.7±3.5 vs 17.0±3.3%）有显著变化（P≤0.05）。
频谱脑电图是诊断伴有MHE的肝硬化患者以及评估其治疗反应的一种有用的客观定量工具。
