Gitlin N, Lewis D C, Hinkley L
J Hepatol. 1986;3(1):75-82. doi: 10.1016/s0168-8278(86)80149-0.
Thirty-seven patients, all with histologic evidence of cirrhosis and with a normal neurological examination and normal mental status were evaluated by psychometric testing for subclinical hepatic encephalopathy. They were all regarded as having well compensated cirrhosis, not requiring any treatment or dietary restrictions and they were working, and many of them driving. A group of 19 patients with a history of alcoholism, or medical disorders, but without clinical or biochemical evidence of cirrhosis, served as controls. They were matched by age, sex, education, and alcohol consumption. Investigations performed were an EEG, fasting arterial ammonia, liver biochemical tests and a series of verbal and performance psychometric tests. The EEG was abnormal in 3 (8.3%) of patients, the ammonia elevated in 17 (45.9%) of patients and 26 patients (70.3%) failed 2 or more psychometric tests, as compared to 2 (10.5%) of the control group. It is concluded that 2 out of 3 patients with stable, well compensated cirrhosis were suffering from subclinical hepatic encephalopathy and that impairment of performance rather than verbal skills occurred. The digital symbol test, trail test (number connection test) and block design tests readily identified the patients with subclinical hepatic encephalopathy. The implication of these observations in patients with cirrhosis, especially those working in mechanical or skilled occupations, needs consideration.
37例患者均有肝硬化的组织学证据，且神经系统检查和精神状态正常，通过心理测量测试评估是否存在亚临床肝性脑病。他们均被视为肝硬化代偿良好，无需任何治疗或饮食限制，且都在工作，其中许多人还能开车。一组19例有酗酒史或患有其他疾病但无肝硬化临床或生化证据的患者作为对照。两组在年龄、性别、教育程度和酒精摄入量方面进行了匹配。所进行的检查包括脑电图（EEG）、空腹动脉血氨、肝脏生化检查以及一系列语言和操作心理测量测试。与对照组的2例（10.5%）相比，患者组中3例（8.3%）脑电图异常，17例（45.9%）血氨升高，26例（70.3%）在两项或更多心理测量测试中未通过。得出的结论是，3例稳定的、代偿良好的肝硬化患者中有2例患有亚临床肝性脑病，且出现的是操作能力受损而非语言技能受损。数字符号测试、连线测试（数字连接测试）和积木图案测试能轻易识别出亚临床肝性脑病患者。需要考虑这些观察结果对肝硬化患者，尤其是从事机械或技术职业患者的影响。
