非肝硬化性门静脉高压患者的肝性脑病：描述、患病率及危险因素

Hepatic encephalopathy in patients with non-cirrhotic portal hypertension: Description, prevalence and risk factors.

作者信息

Nicoletti Valeria, Gioia Stefania, Lucatelli Pierleone, Nardelli Silvia, Pasquale Chiara, Nogas Sobrinho Stefano, Pentassuglio Ilaria, Greco Francesca, De Santis Adriano, Merli Manuela, Riggio Oliviero

机构信息

Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.

Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University of Rome, Rome, Italy.

出版信息

Dig Liver Dis. 2016 Sep;48(9):1072-7. doi: 10.1016/j.dld.2016.06.014. Epub 2016 Jun 30.

DOI:10.1016/j.dld.2016.06.014

PMID:27448844

Abstract

BACKGROUND

Hepatic encephalopathy (HE) is a common complication of cirrhosis but it is less studied in patients with non-cirrhotic portal hypertension (NCPH).

AIMS

To describe the prevalence of cognitive impairment (overt and covert HE) in NCPH patients and to identify the risk factors for its development.

METHODS

51 patients with NCPH, 35 with chronic portal vein thrombosis (PVT) and 16 with idiopathic non-cirrhotic portal hypertension (INCPH), were evaluated for the presence of previous or present overt HE (OHE). The psychometric hepatic encephalopathy score and the SCAN battery were used to detect the presence of covert HE (CHE). 34 compensated cirrhotic patients were used as control. In NCPH patients, abdominal scans were performed to detect the presence of shunts.

RESULTS

None of the patients experienced OHE at evaluation while 5.7% of PVT and 12.5% of INCPH patients referred at least one documented episode of previous OHE, similarly to patients with cirrhosis (14.7%). Even if lower than in patients with cirrhosis (64.7%), a considerable proportion of patients with chronic PVT (34.3%) and INCPH (25%) had CHE (p=0.008). The presence of a large portal-systemic shunt was the only factor significantly correlated to cognitive impairment in NCPH patients.

CONCLUSION

HE is a tangible complication of NCPH and is mainly related to the presence of portal-systemic shunts.

摘要

背景

肝性脑病（HE）是肝硬化的常见并发症，但在非肝硬化门静脉高压（NCPH）患者中的研究较少。

目的

描述NCPH患者认知障碍（显性和隐性HE）的患病率，并确定其发生的危险因素。

方法

对51例NCPH患者进行评估，其中35例为慢性门静脉血栓形成（PVT），16例为特发性非肝硬化门静脉高压（INCPH），评估既往或当前显性HE（OHE）的存在情况。采用心理测量肝性脑病评分和SCAN成套测验来检测隐性HE（CHE）的存在。34例代偿期肝硬化患者作为对照。对NCPH患者进行腹部扫描以检测分流的存在情况。

结果

在评估时，所有患者均未发生OHE，而5.7%的PVT患者和12.5%的INCPH患者报告至少有一次既往OHE记录事件，与肝硬化患者（14.7%）相似。即使低于肝硬化患者（64.7%），仍有相当比例的慢性PVT患者（34.3%）和INCPH患者（25%）存在CHE（p = 0.008）。存在大的门体分流是NCPH患者中与认知障碍显著相关的唯一因素。