临界视频闪烁频率与轻微肝性脑病诊治相关性研究

发布时间：2018-12-12 09:33

【摘要】：背景轻微肝性脑病（Minimal hepatic encephalopathy,MHE）是指临床上没有肝性脑病相关症状和血液学检查异常，但用精细的智力试验或神经电生理检查可见智力、神经、精神的异常而诊断的肝性脑病，，常并发于慢性肝功能异常的神经认知功能紊乱。发现于上世纪80年代。有调查显示约80%的肝硬化患者患有MHE。其临床症状隐匿，很难发现及诊断。严重影响患者的认知、观察等能力。目前临床上有很多检测方法用来诊断MHE，但对于MHE的诊断一直尚无统一的诊断标准。目的 (1)分析轻微性肝性脑病的发病情况、探讨发病可能存在的危险因素； (2)分析临界视频闪烁仪在轻微肝性脑病的诊断、监测病情变化方面的价值； (3)评价早期干预对MHE的临床价值及探讨视频闪烁临界值与病情严重程度的关系。方法连续收集2013年10月至2014年1月北京军区总院肝病治疗中心肝硬化患者80例。每位受试者均进行临界视频闪烁频率（critical flicker frequency，CFF）及心理计量测试(psychometric test,PHES），抽取清晨空腹静脉血检测血氨值、谷丙转氨酶、胆红素、白蛋白、胆碱酯酶、凝血时间。经彩色多普勒超声测量门静脉宽度、门静脉平均血流速度、以Child-pugh分级评估受试者的肝功能状态。CFF值及PHES值均阳性者诊断MHE。根据诊断结果将80名患者分为MHE组与非MHE组；诊断MHE的肝硬化患者给予门冬氨酸鸟氨酸10g1/日，静滴。并在治疗5天后观察其血氨值、DST、NCT及CFF值。结果 (1)MHE患者血氨值（121.1±13.6μmol/L）及凝血酶原时间（14.29±5.73s）高于非MHE患者血氨（98.3±10.1μmol/L）凝血酶原时间（12.73±6.38s）；差异有统计学意义(P0.05）。且肝硬化患者Child-pugh分级的级数越高则罹患MHE的风险越高。而谷丙转氨酶、胆红素、白蛋白、胆碱酯酶、门静脉宽度及门静脉平均血流速度等指标的差异无统计学意义。 (2)CFF在诊断MHE方面具有较好的诊断效能，与心理计量测试具有较好的一致性（kappa=0.8）。（3）门冬氨酸鸟氨酸治疗后，MHE患者CFF值（38.2±4.3Hz）较治疗前差异有统计学意义（P0.05）。结果与静脉血氨、DST结果相一致，说明CFF可以提示评估MHE的病情程度。结论 (1)肝硬化患者凝血酶原时间、血氨升高、Child-pugh分级越高则罹患MHE的可能性越大。 (2) CFF在诊断MHE方面具有较好的诊断效能，与临床上应用较为广泛的心理计量测试具有较好的一致性。 (3)早期诊断、干预可以有效控制及缓解MHE；临界视频闪烁频率可以帮助临床医生监测患者的病情变化。
[Abstract]:Background mild hepatic encephalopathy (Minimal hepatic encephalopathy,MHE) means that there are no clinical symptoms associated with hepatic encephalopathy and hematologic abnormalities, but intelligence and nerves can be seen by subtle intelligence tests or neuroelectrophysiological tests. Hepatic encephalopathy diagnosed by mental abnormality is often complicated with neurocognitive disorder of chronic liver dysfunction. It was discovered in the 1980 s. A survey showed that about 80% of patients with liver cirrhosis had MHE. Its clinical symptom is concealed, it is very difficult to find and diagnose. The ability of cognition, observation and so on is seriously affected. There are many clinical methods to diagnose MHE, but there is no uniform diagnostic standard for MHE. Objective (1) to analyze the incidence of mild hepatic encephalopathy and explore the possible risk factors, (2) to analyze the value of critical video scintillation in the diagnosis and monitoring of mild hepatic encephalopathy. (3) to evaluate the clinical value of early intervention in MHE and to explore the relationship between the critical value of video flicker and the severity of the disease. Methods from October 2013 to January 2014, 80 patients with liver cirrhosis were collected. The critical video scintillation frequency (critical flicker frequency,CFF) and psychometric test (psychometric test,PHES) were used to detect serum ammonia, alanine aminotransferase, bilirubin, albumin, cholinesterase and coagulation time. The width of portal vein and the mean velocity of portal vein were measured by color Doppler ultrasound. The liver function was evaluated by Child-pugh grade. The patients with positive CFF and PHES were diagnosed with MHE.. According to the diagnostic results, 80 patients were divided into MHE group and non-MHE group. Patients with liver cirrhosis diagnosed with MHE were given ornithine aspartate 10g1/ intravenously. Blood ammonia, DST,NCT and CFF were observed 5 days after treatment. Results (1) the blood ammonia level (121.1 卤13.6 渭 mol/L) and prothrombin time (14.29 卤5.73 s) in patients with MHE were significantly higher than those in patients without MHE (98.3 卤10.1 渭 mol/L) and prothrombin time (12.73 卤6.38 s). The difference was statistically significant (P0.05). The higher the Child-pugh grade, the higher the risk of MHE in patients with cirrhosis. However, there was no significant difference in alanine aminotransferase, bilirubin, albumin, cholinesterase, portal vein width and portal vein mean blood flow velocity. (2) CFF has good diagnostic efficacy in diagnosing MHE and is consistent with psychometric test (kappa=0.8). (3) after ornithine treatment, the CFF value of MHE patients (38.2 卤4.3Hz) was significantly higher than that before treatment (P0.05). The results were consistent with the results of venous blood ammonia and DST, indicating that CFF could be used to evaluate the severity of MHE. Conclusion (1) prothrombin time, blood ammonia and Child-pugh grade are more likely to develop MHE in patients with liver cirrhosis. (2) CFF has good diagnostic efficacy in the diagnosis of MHE, which is consistent with the psychometric test which is widely used in clinic. (3) in early diagnosis, intervention can effectively control and alleviate the critical video flicker frequency of MHE;.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R747.9

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