Nardelli Silvia, Allampati Sanath, Riggio Oliviero, Mullen Kevin D, Prakash Ravi, Gioia Stefania, Unser Ariel, White Melanie B, Fagan Andrew C, Wade James B, Farcomeni Alessio, Gavis Edith A, Bajaj Jasmohan S
Division of Gastroenterology, Sapienza University of Rome, Rome, Italy.
Division of Gastroenterology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Dig Dis Sci. 2017 Mar;62(3):794-800. doi: 10.1007/s10620-016-4425-6. Epub 2016 Dec 30.
Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies.
To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study.
A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart. ICT learning (change in 2nd half lures compared to 1st half) was compared between patient groups at both visits. Change in the PHES individual sub-tests and total score between visits was compared in both groups. US versus Italian trends were also analyzed.
HE patients had worse PHES and ICT results compared to no-HE patients at baseline. Significant improvement (1st half 7.1 vs. 2nd half 6.2, p < 0.0001) was observed in no-HE, but not in HE (1st half 7.9 vs. 2nd half 7.8, p = 0.1) at baseline. At retesting (median 20 days later), no-HE patients continued with significant learning (1st half 6.0 vs. 2nd half 5.4, p < 0.0001), while HE patients again did not improve (1st half 7.8 vs. 2nd half 6.9, p = 0.37). Between visits, no-HE patients improved significantly on four PHES sub-tests and overall score, while HE patients only improved on two sub-tests with similar overall PHES score. Trends were similar between US and Italian subjects.
In this multicenter study, prior HE patients showed persistent significant learning impairment compared to those without prior HE, despite adequate medical therapy. This persistent change should increase efforts to reduce the first HE episode.
在单中心研究中，肝性脑病（HE）的精神状态被认为是可逆的，但认知功能可能并非如此。
在一项多中心研究中，评估既往有HE的患者与从未经历过HE（无HE）的患者相比，学习障碍的持续性。
来自三个中心的174名门诊肝硬化患者（94名来自弗吉尼亚州，30名来自俄亥俄州，50名来自罗马；36名既往有HE）在基线时接受了心理测量肝性脑病评分（PHES）和抑制控制（ICT）测试，然后至少间隔7天再次测试。在两次就诊时，比较了患者组之间的ICT学习情况（后半部分诱捕试验与前半部分相比的变化）。比较了两组就诊期间PHES各个子测试和总分的变化。还分析了美国和意大利患者的趋势。
与无HE患者相比，HE患者在基线时的PHES和ICT结果更差。在无HE患者中观察到显著改善（前半部分7.1对后半部分6.2，p < 0.0001），但在HE患者中未观察到改善（前半部分7.9对后半部分7.8，p = 0.1）。在重新测试时（中位时间为20天后），无HE患者继续有显著学习进步（前半部分6.0对后半部分5.4，p < 0.
