Agarwal Ankit, Taneja Sunil, Chopra Madhu, Duseja Ajay, Dhiman Radha K
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Clin Exp Hepatol. 2020 Jun;6(2):116-124. doi: 10.5114/ceh.2019.95105. Epub 2020 May 8.
Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encepha-lopathy (HE). We compared the usefulness of the Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT) for the diagnosis of MHE and the prediction of the development of overt episodes of HE.
103 consecutive patients with liver cirrhosis without overt HE were subjected to PHES and ANT evaluation. The receiver-operating characteristic curve was used to determine the optimum cut-off of the ANT value for the diagnosis of MHE.
Thirty-seven (35.9%) patients had MHE as assessed by altered PHES. ANT (< 14) was positive in 36 (34.95%) patients with MHE with a sensitivity of 89.19% and specificity of 95.7%, positive predictive value (PPV) of 91.67%, negative predictive value (NPV) of 94.03% and diagnostic accuracy of 93.20%. The area under the curve for diagnosis of MHE was 0.978 (95% CI: 0.954-1.0). MHE patients had significantly lower ANT as compared to non-MHE patients and controls (10.81 ±0.324 vs. 15.27 ±0.147 vs. 15.78 ±0.192, respectively, = 0.01). ANT correlated with PHES ( = 0.752, = 0.001) and also with Child-Pugh ( = -0.408, = 0.001) and MELD ( = -0.318, = 0.001) scores. During follow-up, 14 patients in the MHE group and 4 in the non-MHE group developed overt episodes of HE ( = 0.001).
ANT is simple and accurate for the diagnosis of MHE and prediction of overt episodes of HE in patients with cirrhosis and correlates well with the Child-Pugh and MELD scores.
轻微肝性脑病（MHE）是肝性脑病（HE）谱系中最轻微的形式。我们比较了心理测量肝性脑病评分（PHES）和动物命名测试（ANT）在诊断MHE以及预测显性HE发作发展方面的效用。
对103例无显性HE的连续肝硬化患者进行PHES和ANT评估。采用受试者操作特征曲线来确定用于诊断MHE的ANT值的最佳截断值。
经PHES改变评估，37例（35.9%）患者患有MHE。ANT（<14）在36例（34.95%）MHE患者中呈阳性，敏感性为89.19%，特异性为95.7%，阳性预测值（PPV）为91.67%，阴性预测值（NPV）为94.03%，诊断准确性为93.20%。诊断MHE的曲线下面积为0.978（95%CI：0.954 - 1.0）。与非MHE患者和对照组相比，MHE患者的ANT显著更低（分别为10.81±0.324、15.27±0.147和15.78±0.192，P = 0.01）。ANT与PHES相关（r = 0.752，P = 0.001），也与Child-Pugh评分（r = -0.408，P = 0.001）和MELD评分（r = -0.318，P = 0.001）相关。在随访期间，MHE组有14例患者、非MHE组有4例患者发生显性HE发作（P = 0.001）。
ANT对于肝硬化患者MHE的诊断以及显性HE发作的预测简单且准确，并且与Child-Pugh和MELD评分相关性良好。
