Neye Rebecca Maria, Kircheis Gerald, Stratmann Daria, Hilger Norbert, Lüth Stefan
Department of Gastroenterology, Hepatology and Diabetology, Center of Internal Medicine II, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany,
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Ernst von Bergmann Potsdam, Potsdam, Germany,
Dig Dis. 2024;42(6):567-575. doi: 10.1159/000538924. Epub 2024 Jun 12.
An early detection of low-grade hepatic encephalopathy (HE) is of high importance. The aim of the study was to compare a neuropsychological with a psychophysical test on the basis of the psychometric hepatic encephalopathy score (PHES) regarding effectiveness in diagnosing minimal HE (MHE).
In our prospective controlled observational study, we examined a total of 103 patients with liver cirrhosis for HE. The PHES, CFF, and EncephalApp were performed in all patients. Graduation was based on the result of the PHES. Patients without evidence for HE 1&2 according to the mental state (West-Haven criteria) with a PHES <-4 value points and no clinical symptoms were defined as having MHE. Patients were considered as HE0 when in the PHES none of the psychometric subtest results was abnormal or with a PHES ≥-4 value points. Patients with clinical symptoms were considered HE 1&2 patients. Different cut-off values were determined, and their specificity and sensitivity were calculated.
Ninety-six of the involved patients had liver cirrhosis and 25 acted as a healthy control group. The ROC analysis for the classification resulted in an AUC of 0.806, with the highest Youden index for the cut-off time >224 s, for which the sensitivity was 82% and the specificity 75%. Cases of withdrawals were seen in 10.74% of all tested patients.
The EncephalApp distinguishes well between HE0 and MHE but has its limitations in grading higher forms of HE. Diagnosis using only the EncephalApp is not sufficient.
早期发现轻度肝性脑病（HE）至关重要。本研究旨在基于心理测量肝性脑病评分（PHES），比较神经心理学测试和心理物理学测试在诊断轻微肝性脑病（MHE）方面的有效性。
在我们的前瞻性对照观察研究中，我们共检查了103例肝硬化患者是否患有肝性脑病。所有患者均进行了PHES、临界闪光融合频率（CFF）和EncephalApp测试。分级基于PHES的结果。根据精神状态（韦斯特-黑文标准）无HE 1和2证据、PHES值<-4分且无临床症状的患者被定义为患有MHE。当PHES中没有心理测量子测试结果异常或PHES≥-4分时，患者被视为HE0。有临床症状的患者被视为HE 1和2患者。确定了不同的临界值，并计算了它们的特异性和敏感性。
96例参与患者患有肝硬化，25例作为健康对照组。分类的ROC分析得出曲线下面积（AUC）为0.806，临界时间>224秒时约登指数最高，此时敏感性为82%，特异性为75%。在所有测试患者中，有10.74%出现了退出情况。
EncephalApp能很好地区分HE0和MHE，但在对更高形式的肝性脑病进行分级方面存在局限性。仅使用EncephalApp进行诊断是不够的。
