Qu Yundong, Li Tao, Lin Chunlei, Liu Feng, Wu Shuo, Wang Lei, Ye Qian
Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China.
Department of Hepatology, Tianjin Second People's Hospital, China; Tianjin Institute of Hepatology, China.
Clin Res Hepatol Gastroenterol. 2021 Sep;45(5):101729. doi: 10.1016/j.clinre.2021.101729. Epub 2021 Jun 6.
To evaluate the diagnostic performance of simplified animal naming test (S-ANT1) for minimal hepatic encephalopathy (MHE) in patients with cirrhosis from a Chinese tertiary centre and to optimize the application strategy of S-ANT1 in clinical practice.
The Animal Naming Test 1 (ANT1) was performed in all included cirrhotic patients and healthy volunteers. S-ANT1 was calculated to adjust for age and education. Psychometric Hepatic Encephalopathy Score (PHES) was also performed in patients with cirrhosis.
88 cirrhotic patients and 34 healthy control subjects were included. Cirrhotic patients were characterized with lower S-ANT1 scores (P = 0.001). In patients with cirrhosis, score of S-ANT1 was correlated with PHES score, age, school education period, and blood ammonia (all P values <0.05). With ≤20 animals as the cut-off value, S-ANT1 could distinguish MHE and no MHE with a sensitivity of 77.5% and a specificity of 58.3%. A three-step screening strategy, with 90% as a threshold for sensitivity and specificity and two cut-off values "≤12 animals" and ">23 animals", was then formulated to rule out patients with high possibility of MHE and with high possibility of no MHE. The remaining "ruled-in" patients should be further evaluated for MHE using PHES.
S-ANT1 is an important screening tool for MHE in cirrhotic patients. The three-step screening strategy based on S-ANT1 and PHES is conducive to the identification of MHE in clinical practice.
评估简化动物命名测试（S-ANT1）对中国一家三级中心肝硬化患者轻微肝性脑病（MHE）的诊断性能，并优化S-ANT1在临床实践中的应用策略。
对所有纳入的肝硬化患者和健康志愿者进行动物命名测试1（ANT1）。计算S-ANT1并根据年龄和教育程度进行调整。对肝硬化患者还进行了心理测量肝性脑病评分（PHES）。
纳入88例肝硬化患者和34例健康对照者。肝硬化患者的S-ANT1得分较低（P = 0.001）。在肝硬化患者中，S-ANT1得分与PHES得分、年龄、受教育年限和血氨相关（所有P值<0.05）。以≤20只为截断值，S-ANT1区分MHE和非MHE的敏感度为77.5%，特异度为58.3%。然后制定了一个三步筛查策略，以敏感度和特异度90%为阈值，两个截断值“≤12只”和“>23只”，以排除MHE可能性高和无MHE可能性高的患者。其余“纳入”的患者应使用PHES进一步评估MHE。
S-ANT1是肝硬化患者MHE的重要筛查工具。基于S-ANT1和PHES的三步筛查策略有助于在临床实践中识别MHE。
