乙型肝炎肝硬化并发轻微肝性脑病的调查分析

张丽洁; 周英霞; 邢卉春; 苏叶; 孙玉梅

doi:10.3969/j.issn.1001-5256.2018.04.015

乙型肝炎肝硬化并发轻微肝性脑病的调查分析

DOI: 10.3969/j.issn.1001-5256.2018.04.015

1. 北京大学护理学院
2. 北京中医药大学护理学院
3. 北京地坛医院肝病科

详细信息

中图分类号: R512.62;R575
计量
- 文章访问数: 2240
- HTML全文浏览量: 16
- PDF下载量: 455
- 被引次数: 0
出版历程
- 出版日期: 2018-04-20

An investigation of minimal hepatic encephalopathy in patients with hepatitis B cirrhosis

School of Nursing, Peking University

摘要

摘要: 目的调查乙型肝炎肝硬化患者轻微肝性脑病（MHE）的发生情况。方法分别选择2012年6月-2012年12月在首都医科大学附属北京地坛医院门诊就诊的乙型肝炎肝硬化患者（肝硬化组）与健康对照组各105例,采用数字连接试验、Stroop色词测验、画钟测验3项神经心理学测验进行认知功能测评。计量资料2组间比较采用t检验或Wilcoxon秩和检验,计数资料2组间比较采用χ2检验。结果肝硬化组完成NCT-A、NCT-B和CWT-A、CWT-B、CWT-C的耗时明显长于健康对照组（t值分别为-2.158、-2.372、-2.063、-2.611、-4.325,P值均<0.05）,而CDT-1得分要明显低于健康对照组（t=2.884,P<0.05）。乙型肝炎肝硬化患者中共筛出MHE 46例（43.81%）,其中,信息加工速度异常者最高为24例（22.86%）,其次为反应抑制能力异常者17例（16.19%）,视觉空间能力异常者15例（14.29%）,定势转移能力异常者10例（9.52%）。结论肝功能稳定的乙型肝炎肝硬化患者MHE的检出率较高,联合使用神经心理学测试可以提高MHE的检出率。
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 肝性脑病 /
- 神经心理学测验
Abstract: Objective To investigate the prevalence of minimal hepatic encephalopathy (MHE) in patients with hepatitis B cirrhosis.Methods A total of 105 patients with hepatitis B cirrhosis who visited Beijing Ditan Hospital, Capital Medical University, from June to December, 2012 were enrolled as cirrhosis group, and 105 healthy volunteers were enrolled as healthy control group.The number connection test (NCT) , Stroop color-word test (CWT) , and clock drawing test (CDT) were used to evaluate cognitive function.The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Compared with the healthy control group, the cirrhosis group had significantly longer time spent on NCT-A, NCT-B, CWT-A, CWT-B, and CWT-C (t =-2.158, -2.372, -2.063, -2.611, and-4.325, all P < 0.05) and a significantly lower score of CDT-1 (t = 2.884, P < 0.05) .Of all patients with hepatitis B cirrhosis, 46 (43.81%) were diagnosed with MHE, among whom 24 (22.86%) had an abnormal information processing speed, 17 (16.19%) had an abnormal reaction inhibition ability, 15 (14.29%) had an abnormal visuospatial ability, and 10 (9.52%) had an abnormal set-shifting ability.Conclusion There is a high detection rate of MHE in patients with hepatitis B cirrhosis and stable liver function, and a combination of neuropsychological tests can increase the detection rate of MHE.
- hepatitis B, chronic /
- liver cirrhosis /
- hepatic encephalopathy /
- neuropsychological tests

HTML全文

参考文献(16)

[1]YAN M.Selection of the diagnostic and therapeutic methods for minimal hepatic encephalopathy[J].J Clin Hepatol, 2016, 32 (6) :1092-1099. (in Chinese) 阎明.轻微型肝性脑病诊治方法的选择[J].临床肝胆病杂志, 2016, 32 (6) :1092-1099.

[2]BAJAJ JS, CORDOBA J, MULLEN KD, et al.Review article:the design of clinical trials in hepatic encephalopathy——an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement[J].Aliment Pharmacol Ther, 2011, 33 (7) :739-747.

[3]ENNAIFER R, CHEIKH M, HEFAIEDH R, et al.Minimal hepatic encephalopathy:a better diagnostic to improve prognostic[J].Presse Med, 2014, 43 (5) :e127-e133.

[4]Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[5] KE E.The valuation of nerve electrophysiology and intelligence tests in the diagonosis of minimal hepatic encephalopathy in patients with cirrhosis[D].Guangzhou:Guangzhou Med Univ, 2015. (in Chinese) 柯娥.神经电生理及智能检测在肝硬化患者轻微肝性脑病诊断中的价值评估[D].广州:广州医科大学, 2015.

[6]SU L, SUN YM, LIN KK, et al.Investigation of cognitive functions in patients with chronic hepatitis B[J].J Pract Hepatol, 2012, 15 (4) :312-314. (in Chinese) 苏莉, 孙玉梅, 林可可, 等.慢性乙型肝炎患者认知功能的调查研究[J].实用肝脏病杂志, 2012, 15 (4) :312-314.

[7]SUN YM, ZHOU YX, XING HC, et al.Clock drawing test in cognitive assessment for patients with hepatitis B cirrhosis[J].J Clin Hepatol, 2015, 31 (3) :413-417. (in Chinese) 孙玉梅, 周英霞, 邢卉春, 等.画钟测验对乙型肝炎肝硬化患者认知功能的评估[J].临床肝胆病杂志, 2015, 31 (3) :413-417.

[8] Chinese Society of Gastroenterology and Chinese Society of Hepatology, Chinese Medical Association.Consensus on the diagnosis and treatment of hepatic encephalopathy in China (Chongqing, 2013) [J].Chin J Dig, 2013, 33 (9) :81-93. (in Chinese) 中华医学会消化病学分会.中国肝性脑病诊治共识意见 (2013年, 重庆) [J].中华消化杂志, 2013, 33 (9) :81-93.

[9]HAO LC, HU YQ, HOU XH.The relationship between the daily behavior abnormalities and minimal hepatic encephalopathy in patients with cirrhosis or liver failure[J].Chin J Clin Gastroenterol, 2017, 29 (3) :151-154. (in Chinese) 郝良成, 胡阳黔, 侯晓华.肝硬化和重症肝炎患者日常行为异常与轻微肝性脑病关系的探讨[J].临床消化病杂志, 2017, 29 (3) :151-154.

[10]CAO ZL.Studies on illness perception and neuropsychology of patients with chronic HBV infection[D].Hefei:Anhui Med Univ, 2007. (in Chinese) 曹召伦.慢性乙型肝炎病毒感染者疾病认知与神经心理学研究[D].合肥:安徽医科大学, 2007.

[11]WANG Q, LI W, MAO LW, et al.The role of connection test (Chinese Revision) in early identification of dementia free vascular cognitive impairment[J].Chin J Gerontol, 2012, 32 (10) :2018-2020. (in Chinese) 王琦, 李文, 毛礼炜, 等.连线测验 (中文修订版) 在早期识别无痴呆型血管性认知障碍中的作用[J].中国老年学杂志, 2012, 32 (10) :2018-2020.

[12]SHARMA P, SHARMA BC.Predictors of minimal hepatic encephalopathy in patients with cirrhosis[J].Saudi J Gastroenterol, 2010, 16 (3) :181-187.

[13]XIE HG.Cognitive impairment and neuropsychological assessment in Alzheimer's disease[J].Chin J Prac Intern Med, 2010, 30 (10) :883-887. (in Chinese) 解恒革.阿尔茨海默病认知障碍表现与量表检测[J].中国实用内科杂志, 2010, 30 (10) :883-887.

[14]ZHANG LJ, YIN JZ, QI J.The f MRI study of cognitive control in cirrhotic patients[J].J Clin Radiol, 2008, 27 (2) :163-167. (in Chinese) 张龙江, 尹建忠, 祁吉.肝硬化患者认知控制的f MRI研究[J].临床放射学杂志, 2008, 27 (2) :163-167.

[15]YOU XQ, YAN BH.Characteristics of the cognition processing of human visual ability in space[J].J Shaanxi Normal Uni (Philos Social Sci Edit) , 2004, 33 (2) :102-107. (in Chinese) 游旭群, 晏碧华.视觉空间能力的认知加工特性[J].陕西师范大学学报 (哲学社会科学版) , 2004, 33 (2) :102-107.

[16]FU YZ, XIE JW.The application of clock drawing test and MMSE in diagnosis of minimal hepatic encephalopathy[J].J Clin Res, 2007, 24 (8) :1280-1282. (in Chinese) 符应征, 谢俊维.画钟试验和MMSE在轻微肝性脑病诊断中的应用[J].医学临床研究, 2007, 24 (8) :1280-1282.

施引文献

资源附件(0)

访问统计