Bale Abhijith, Pai C Ganesh, Shetty Shiran, Balaraju Girisha, Shetty Anurag
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.
J Clin Exp Hepatol. 2018 Jun;8(2):156-161. doi: 10.1016/j.jceh.2017.06.005. Epub 2017 Jun 20.
BACKGROUND/OBJECTIVES: Minimal hepatic encephalopathy (MHE), though highly prevalent, is a frequently underdiagnosed complication of cirrhosis of the liver. Because lack of time is reported as the major reason for non-testing, identifying patients at high risk of MHE would help in targeting them for screening. We aimed to determine the factors associated with MHE to help identify patient subgroups with a higher risk of MHE for targeted screening.
Patients with cirrhosis of liver presenting between April 2015 and November 2016 were included. Those with a Psychometric Hepatic Encephalopathy Score (PHES) of ≤-5 points on psychometric testing were diagnosed to have MHE. Various demographic, clinical and laboratory parameters were included in a univariate and later multiple logistic regression models.
Of the 180 (male = 166, 92.2%) patients included 94 (52.2%) had MHE. Though serum albumin, serum total bilirubin, serum aspartate aminotransferase, international normalized ration, Child-Turcotte-Pugh and Model-For-End-Stage-Liver-Disease scores were significant on univariate analysis, only CTP score was found to be significantly associated with MHE ( = 0.002) on multivariate analysis. A higher CTP class was associated with a higher risk of the presence of MHE. The Odds ratio for having MHE was higher with CTP classes of B ( ≤ 0.001) and C ( ≤ 0.001) compared to class A.
MHE is a common complication in patients with cirrhosis of liver and higher CTP scores independently predict the presence of MHE. Patients with CTP class B and C have a higher risk of suffering from MHE than CTP class A. Screening of patients in CTP class B and C is likely to increase the MHE detection rates while saving time, although select CTP class A patients may also need screening in view of public safety or poor quality of life.
背景/目的：轻微肝性脑病（MHE）虽然极为常见，但却是肝硬化一种常被漏诊的并发症。由于报告称时间不足是未进行检测的主要原因，识别MHE高危患者将有助于针对他们进行筛查。我们旨在确定与MHE相关的因素，以帮助识别MHE风险较高的患者亚组，进行有针对性的筛查。
纳入2015年4月至2016年11月期间就诊的肝硬化患者。心理测量肝性脑病评分（PHES）在心理测量测试中≤ -5分的患者被诊断为患有MHE。各种人口统计学、临床和实验室参数被纳入单变量分析，随后纳入多变量逻辑回归模型。
纳入的180例患者（男性 = 166例，占92.2%）中，94例（52.2%）患有MHE。虽然血清白蛋白、血清总胆红素、血清天冬氨酸转氨酶、国际标准化比值、Child-Turcotte-Pugh评分和终末期肝病模型评分在单变量分析中具有显著性，但在多变量分析中，仅发现CTP评分与MHE显著相关（P = 0.002）。较高的CTP分级与MHE存在的较高风险相关。与A类相比，B类（P ≤ 0.001）和C类（P ≤ 0.001）CTP分级的患者发生MHE的比值比更高。
MHE是肝硬化患者的常见并发症，较高的CTP评分可独立预测MHE的存在。CTP分级为B级和C级的患者患MHE的风险高于CTP分级为A级的患者。对CTP分级为B级和C级的患者进行筛查可能会提高MHE的检出率，同时节省时间，不过鉴于公共安全或生活质量较差，部分CTP分级为A级的患者也可能需要进行筛查。
