简化版动物命名试验对肝硬化并发轻微性肝性脑病的诊断价值及相关因素分析*

doi:10.3969/j.issn.1672-5069.2023.01.022

摘要/Abstract

摘要： 目的探讨应用简化版动物命名试验(S-ANT)诊断肝硬化并发轻微性肝性脑病(MHE)的价值。方法 2020年7月～2021年6月于蚌埠医学院第一附属医院感染病科和阜阳市第二人民医院肝病科住院治疗的142例肝硬化患者,采用数字连接试验A(NCT-A)、数字符号试验(DST)、动物命名试验(ANT)筛查肝硬化并发MHE患者。常规检测血常规、血生化常规和血氨,应用多因素Logistic回归分析肝硬化并发MHE的相关因素。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价S-ANT诊断MHE的效能。结果在142例肝硬化患者中,发生MHE者39例(27.5%);MHE组患者年龄、受教育年限和酒精性肝病占比与无MHE组比,差异显著(P<0.05);MHE组血氨水平为61.0(36.0～94.0)μmol/L,显著高于无MHE组【(47.1(33.0～69.0)μmol/L,P<0.05】;MHE组NCT-A用时为(93.5±38.9)s,显著长于无MHE组【(61.5±23.7)s,P<0.05】,DST、ANT和S-ANT评分分别为(22.7±5.7)分、(12.5±1.5)分和(14.4±2.0)分,均显著低于无MHE组【分别为(36.9±10.4)分、(17.6±3.9)分和(18.7±3.8),P<0.05】;多因素Logistic回归分析显示,年龄(OR=1.07,95%CI 1.02～1.14,P<0.05)、受教育年限(OR=0.78,95%CI 0.65～0.94,P<0.05)和血氨水平(OR=1.02,95%CI 1.00～1.04,P<0.05)是发生MHE的独立影响因素;S-ANT诊断肝硬化患者并发MHE的曲线下面积(AUC)为0.781,最佳截断点为<16分,其敏感度为71.8％,特异度为84.5％。结论 S-ANT诊断肝硬化并发MHE简便、有效,值得临床开展论证研究。

关键词: 肝硬化, 轻微型肝性脑病, 简化版动物命名试验, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic performance of simplified animal nomenclature test (S-ANT) in predicting minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis (LC). Methods 142 patients with LC were encountered in the Department of Infectious Diseases, First Affiliated Hospital, Bengbu Medical College and the Department of Hepatology, Second People's Hospital, Fuyang, Anhui province between July 2020 and June 2021, and the number connection test-A (NCT-A), digit symbol test(DST), simplified animal naming test(ANT) were conducted for the diagnosis of MHE. The multivariate Logistic regression analysis was performed, the receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of S-ANT for MHE. Results Among the 142 patients with LC, the MHE was found in 39 cases (27.5%); there were significant differences with respect to the ages, education periods and the percentage of alcoholic liver disease between patients with and without MHE(P<0.05);serum ammonia level in patients with MHE was 61.0(36.0, 94.0)μmol/L, much higher than [(47.1(33.0, 69.0)μmol/L, P<0.05] in patients without MHE; the NCT-A in patients with MHE lasted for (93.5±38.9)s, much longer than [(61.5±23.7)s, P<0.05], and the DST, ANT and S-ANT scores were (22.7±5.7), (12.5±1.5) and (14.4±2.0), all significantly higher than [(36.9±10.4), (17.6±3.9) and (18.7±3.8), respectively, P<0.05] in patients without MHE; the multivariate Logistic regression analysis showed that the age(OR=1.07, 95%CI 1.02-1.14, P<0.05), education period (OR=0.78, 95%CI 0.65-0.94, P<0.05) and serum ammonia level (OR=1.02, 95%CI 1.00-1.04, P<0.05) were all the independent factors for the occurrence of MHE; the AUC was 0.781, with the sensitivity of 71.8％ and the specificity of 84.5％, when the cut-off-value of S-ANT less than 16 was applied to predict the MHE in patients with LC. Conclusion The S-ANT is a good diagnostic tool for the assessment of MHE in patients with LC, which might be applied to screen and early find the suspicious patients.

Key words: Liver cirrhosis, Minimal hepatic encephalopathy, Simplified animal naming test, Diagnosis

刘南南, 李卫, 赵守松. 简化版动物命名试验对肝硬化并发轻微性肝性脑病的诊断价值及相关因素分析^*[J]. 实用肝脏病杂志, 2023, 26(1): 83-86.

Liu Nannan, Li Wei, Zhao Shousong. Diagnostic performance of simplified animal nomenclature test in predicting minimal hepatic encephalopathy in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2023, 26(1): 83-86.

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简化版动物命名试验对肝硬化并发轻微性肝性脑病的诊断价值及相关因素分析^*

Diagnostic performance of simplified animal nomenclature test in predicting minimal hepatic encephalopathy in patients with liver cirrhosis

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