Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Aliment Pharmacol Ther. 2018 Aug;48(3):313-321. doi: 10.1111/apt.14824. Epub 2018 Jun 4.
Minimal hepatic encephalopathy (HE) and HE grade 1 (HE1) according to the West Haven criteria have recently been grouped as one entity named-covert HE- (CHE). Data regarding the impact of CHE on health-related quality of life (HRQoL) and sleep quality are controversial.
First, to determine whether CHE affects HRQoL and sleep quality of cirrhotic patients and second, whether minimal HE (MHE) and HE1 affect HRQoL and sleep quality to a comparable extent.
A total of 145 consecutive cirrhotic patients were enrolled. HE1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE. Chronic Liver Disease Questionnaire (CLDQ) was used to assess HRQoL and Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep quality.
Covert HE was detected in 59 (40.7%) patients (MHE: n = 40; HE1: n = 19). Multivariate analysis identified CHE (P < 0.001) and female gender (P = 0.006) as independent predictors of reduced HRQoL (CLDQ total score). CHE (P = 0.021), low haemoglobin (P = 0.024) and female gender (P = 0.003) were identified as independent predictors of poor sleep quality (PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE1 and MHE (CLDQ: 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI: 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3).
Covert HE was associated with impaired HRQoL and sleep quality. MHE and HE1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.
根据 West Haven 标准，轻微肝性脑病 (HE) 和 HE1 最近被归为一个实体，称为隐匿性肝性脑病 (CHE)。关于 CHE 对健康相关生活质量 (HRQoL) 和睡眠质量影响的数据存在争议。
首先，确定 CHE 是否会影响肝硬化患者的 HRQoL 和睡眠质量，其次，确定轻微 HE (MHE) 和 HE1 是否会以类似的程度影响 HRQoL 和睡眠质量。
共纳入 145 例连续肝硬化患者。根据 West Haven 标准临床诊断 HE1。使用临界闪烁频率和心理肝脏脑病评分检测 MHE。使用慢性肝脏疾病问卷 (CLDQ) 评估 HRQoL，使用匹兹堡睡眠质量指数 (PSQI) 评估睡眠质量。
59 例 (40.7%) 患者检测到隐匿性肝性脑病 (MHE：n=40；HE1：n=19)。多变量分析确定 CHE (P<0.001) 和女性性别 (P=0.006) 是 HRQoL 降低 (CLDQ 总分) 的独立预测因素。CHE (P=0.021)、低血红蛋白 (P=0.024) 和女性性别 (P=0.003) 被确定为睡眠质量差 (PSQI 总分) 的独立预测因素。HE1 和 MHE 患者的 CLDQ 和 PSQI 结果相当 (CLDQ：4.6±0.9 vs 4.5±1.2，P=0.907；PSQI：11.3±3.8 vs 9.9±5.0，P=0.3)。
隐匿性肝性脑病与 HRQoL 和睡眠质量受损有关。MHE 和 HE1 对这两种结果的影响程度相当，支持在临床实践中使用 CHE 作为一种对这两种肝性脑病患者均有用的临床术语。
