斯特鲁普测试对轻微性肝性脑病的诊断价值

王腾; 朱伊静; 赵守松

doi:10.3969/j.issn.1001-5256.2022.04.017

斯特鲁普测试对轻微性肝性脑病的诊断价值

DOI: 10.3969/j.issn.1001-5256.2022.04.017

蚌埠医学院第一附属医院感染性疾病科，安徽蚌埠 233000

伦理学声明：本研究方案于2021年2月1日经由蚌埠医学院第一附属医院伦理委员会审批，批号：2021KY006。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：王腾负责设计研究方案，设计论文框架，统计分析，撰写论文；朱伊静负责实施研究过程，采集整理数据；赵守松负责提出研究选题，修订论文，确定研究方案并提供指导性支持。

详细信息

通信作者:
赵守松, 1260345655@qq.com

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出版历程
- 收稿日期: 2021-08-25
- 录用日期: 2021-10-09
- 出版日期: 2022-04-20

Value of Stroop test in the diagnosis of minimal hepatic encephalopathy

Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China

More Information

Corresponding author: ZHAO Shousong, 1260345655@qq.com (ORCID: 0000-0002-8076-518X)

摘要

摘要: 目的探讨神经心理学测试——斯特鲁普(Stroop)测试对轻微性肝性脑病(MHE)的诊断价值。方法选取2020年8月-2021年3月于蚌埠医学院第一附属医院感染性疾病科住院治疗的96例肝硬化患者, 进行数字连接试验A(NCT-A)、数字符号试验(DST)、动物命名试验(ANT)及Stroop测试, 记录测试结果并收集临床数据。正态分布的计量资料组间比较采用t检验; 非正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ²检验。采用ROC曲线评价Stroop测试对MHE的诊断价值, Pearson相关系数分析Stroop测试结果与NCT-A、DST、ANT的相关性。结果 96例肝硬化患者中, MHE患病率为30.21%(29/96)。Stroop测试的Off+On总时间诊断MHE时的截断值为212.49 s, 其AUC为0.845, 敏感度为93.10%, 特异度为64.20%。Pearson相关系数分析结果显示, Stroop测试结果中的On+Off时长、On时长与NCT-A呈中等相关(r值分别为0.580、0.590, P值均 < 0.01), Off时长与NCT-A呈强相关(r=0.620, P < 0.01);On+Off时长、On时长、Off时长与DST均呈强相关(r值分别为-0.650、-0.650、0.630, P值均 < 0.01)。结论在诊断MHE中, Stroop测试是一项敏感度高、无需专业设备、结果易读、诊断价值高的方法。
- 肝性脑病 /
- Stroop测试 /
- 诊断
Abstract: Objective To investigate the value of Stroop test, a neuropsychological test, in the diagnosis of minimal hepatic encephalopathy (MHE). Methods A total of 96 patients with liver cirrhosis who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, from August 2020 to March 2021 were enrolled, and the number connection test-A (NCT-A), digit symbol test (DST), animal naming test (ANT), and Stroop test were performed for all patients. Test results were recorded and related clinical data were collected. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was used to investigate the value of Stroop test in the diagnosis of MHE, and the Pearson correlation coefficient was used to analyze the correlation of the results of Stroop test with those of NCT-A, DST, and ANT. Results For the 96 patients with liver cirrhosis, the prevalence rate of MHE was 30.21% (29/96). The Off+On time of Stroop test had a cut-off value of 212.49 s in the diagnosis of MHE, with an area under the ROC curve of 0.845, a sensitivity of 93.10%, and a specificity of 64.20%. The Pearson correlation analysis showed that the On+Off time and On time of Stroop test were moderately correlated with NCT-A(r=0.580 and 0.590, both P < 0.01), the Off time of Stroop test was strongly correlated with NCT-A(r=0.620, P < 0.01), and the On+Off time, On time, and Off time of Stroop test were strongly correlated with DST(r=-0.650, -0.650, and -0.630, all P < 0.01). Conclusion In the diagnosis of MHE, Stroop test is a highly sensitive method with easy-to-read results and a high diagnostic value and does not require professional equipment.
- Hepatic Encephalopathy /
- Stroop Test /
- Diagnosis

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图 1 Stroop测试、NCT-A、DST和ANT用于肝硬化MHE诊断的ROC曲线

Figure 1. ROC curve of Stroop test, NCT-A, DST and ANT for MHE diagnosis

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表 1 MHE患者与无MHE患者一般资料比较

Table 1. Comparison of general data between patients with MHE and without MHE

指标	MHE组(n=29)	无MHE组(n=67)	统计值	P值
年龄(岁)	52.07±7.91	46.34±9.30	t=2.891	0.005
WBC(×10⁹/L)	3.75(2.50~5.28)	4.21(3.16~6.24)	Z=-1.540	0.124
NEUT(×10⁹/L)	2.20(1.41~2.78)	2.17(1.65~4.04)	Z=-0.938	0.348
RBC(×10¹²/L)	3.64±0.87	3.90±0.79	t=-1.475	0.144
PLT(×10⁹/L)	74.50(48.50~111.25)	95.00(56.00~153.00)	Z=-1.313	0.189
PT(s)	14.40(12.58~17.88)	13.60(12.30~16.00)	Z=-1.217	0.223
PTA(%)	68.18±19.60	74.17±18.74	t=-1.418	0.159
FIB(g/L)	2.08(1.61~2.46)	2.22(1.58~3.03)	Z=-0.682	0.495
ALT(U/L)	29.00(19.25~55.00)	43.00(22.00~66.00)	Z=-1.465	0.143
AST(U/L)	40.00(28.75~87.50)	59.00(38.00~114.00)	Z=-1.751	0.080
ALP(U/L)	88.00(66.50~101.50)	110.00(77.00~160.00)	Z=-2.326	0.020
TBil(μmol/L)	23.80(19.65~43.28)	25.60(14.60~49.70)	Z=-0.539	0.590
Alb(g/L)	32.15±6.61	31.92±5.59	t=0.173	0.863
SCr(μmol/L)	64.00(50.25~71.00)	61.00(51.00~69.00)	Z=-0.419	0.675
K⁺(mmol/L)	3.75±0.42	3.91±0.44	t=-1.639	0.105
CRP(mg/L)	3.40(1.93~17.13)	6.40(2.30~28.70)	Z=-0.950	0.342
血浆氨	71.45±29.89	64.16±26.10	t=1.201	0.233
MELD评分	12.00(8.25~14.75)	10.00(8.00~14.00)	Z=-0.789	0.430

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表 2 Stroop测试、NCT-A、DST和ANT对MHE诊断的ROC曲线结果

Table 2. ROC curve results of Stroop test, NCT-A, DST and ANT for MHE diagnosis

指标	AUC	截断值	敏感度(%)	特异度(%)
Off时长	0.837	110.62 s	82.80	73.10
On时长	0.837	107.42 s	82.80	70.10
Off+On时长	0.845	212.49 s	93.10	64.20
ANT	0.065	14.50个	0	14.90
NCT-A	0.788	58.61 s	89.70	58.20
DST	0.172	29.50分	10.30	34.30

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