Amodio P, Quero J C, Del Piccolo F, Gatta A, Schalm S W
SplenoEpatologia University of Padova, Italy.
Metab Brain Dis. 1996 Dec;11(4):315-27. doi: 10.1007/BF02029493.
The prevalence of subclinical hepatic encephalopathy (SHE) varies according to the diagnostic tool used in its detection. Since a standardised approach to the diagnosis of SHE is not yet available, we compared psychometric tests and EEG spectral analysis. On the same day 32 cirrhotic patients without overt hepatic encephalopathy and 18 controls were assessed by psychometric tests, both standard and computerized (CPT), and by EEG spectral analysis (EEG-SA). The CPT, measuring reaction time (Rt) and errors (er), were Font, Choice1, Choice2 and Scan test. The standard psychometric tests were the number connection test (NCT), the Reitan-B test, the Line Tracing Test [for time: LTT(t) and for errors: LTT(er)], and the Symbol Digit test (SD). Both psychometric tests [Reitan-B test, LTT(er) and CPT but Font (Rt) and Choice2 (er)] and EEG-SA parameters [mean dominant frequency (MDF) and theta power (theta %)] significantly correlated (p < 0.05) with albumin plasma levels. LTT(er), Scan, Font, Choice1 and Choice2 were significantly related to theta % and MDF. There was no control with positive EEG-SA, though one control was positive with LTT(t) and with the number of errors made during Font and Scan tests. The percentage of cirrhotics with positive EEG-SA was 34% (CI95% = 19-53), while 9-66% were positive with psychometric tests, depending on the test considered. In spite of the correlation between neuropsychological and neurophysiological parameters, the diagnostic agreement between EEG-SA and each psychometric test was not high.
亚临床肝性脑病（SHE）的患病率因检测所用诊断工具而异。由于尚未有标准化的SHE诊断方法，我们比较了心理测量测试和脑电图频谱分析。同一天，对32例无明显肝性脑病的肝硬化患者和18名对照者进行了心理测量测试，包括标准测试和计算机化测试（CPT），以及脑电图频谱分析（EEG-SA）。CPT测量反应时间（Rt）和错误数（er），包括字体、选择1、选择2和扫描测试。标准心理测量测试包括数字连接测试（NCT）、瑞坦- B测试、线追踪测试[时间：LTT（t），错误数：LTT（er）]和符号数字测试（SD）。心理测量测试[瑞坦- B测试、LTT（er）和CPT，但字体（Rt）和选择2（er）]以及EEG-SA参数[平均优势频率（MDF）和θ波功率（θ%）]均与血浆白蛋白水平显著相关（p < 0.05）。LTT（er）、扫描、字体、选择1和选择2与θ%和MDF显著相关。EEG-SA检查结果为阳性的对照组中无此类情况，不过有一名对照者LTT（t）以及在字体和扫描测试中出现的错误数检查结果为阳性。EEG-SA检查结果为阳性的肝硬化患者比例为34%（95%CI = 19 - 53），而心理测量测试结果为阳性的比例为9 - 66%，具体取决于所考虑的测试。尽管神经心理学和神经生理学参数之间存在相关性，但EEG-SA与每项心理测量测试之间的诊断一致性并不高。
1）发现无明显肝性脑病的肝硬化患者的神经生理学和神经心理学损害相互关联且与肝功能障碍有关；2）心理测量测试对脑电图改变的预测能力不足；因此，在检测肝病患者的中枢神经系统功能障碍方面，神经心理学工具不能替代神经生理学工具。
