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.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
Eur J Intern Med. 2019 Feb;60:96-100. doi: 10.1016/j.ejim.2018.08.008. Epub 2018 Aug 19.
Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre.
143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1.
58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youden's index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%.
S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.
在临床实践中，隐匿性肝性脑病（CHE）的诊断较为耗时。最近，一种新的诊断工具——简化动物命名测试（S-ANT1）——在意大利队列中取得了有前景的结果。本研究旨在验证 S-ANT1 在德国一家三级转诊中心的肝硬化患者队列中的有效性。
共纳入 143 例肝硬化患者和 37 名健康对照者。根据 West-Haven 标准，临床诊断为肝性脑病 1 级（HE1）。临界闪烁频率和精神性肝性脑病评分用于检测微小肝性脑病（MHE）。所有参与者均接受 S-ANT1 检查。
58 例（40.6%）患者存在 CHE（40 例 MHE，18 例 HE1）。HE1 患者的 S-ANT1 最低，其次是 MHE 患者、无 CHE 患者和健康对照组（均 p<0.05）。在 ROC 分析中，命名<20 种动物可最佳区分 CHE 患者与非 CHE 患者（具有约登指数）。当截断值≥23 时，可避免对 CHE 进一步检测，对 CHE 检测呈阴性的患者中，可避免进一步检测的比例为 38.5%，阴性预测值为 84%。
S-ANT1 可能成为临床实践中 CHE 评估的重要初步筛查工具。
