轻型肝性脑病患者脑电图与临床相关指标的相关性

发布时间：2018-08-03 08:25

【摘要】：肝性脑病(hepatic encephalopathy,HE)是一个复杂的神经精神综合征,临床上表现为认知、行为和机能障碍,其与肝衰竭和或门体静脉分流有关,主要表现为意识障碍、行为失常和昏迷。HE是急性和慢性肝脏疾病严重、致死的并发症,如不及时纠正,甚至会危及生命。肝性脑病的发病机制目前公认的是氨中毒学说,血氨的生成及代谢决定肝性脑病的病情进展,治疗上主要是解除HE诱因及降血氨等治疗来达到临床上的治愈。根据患者精神状况、临床指标和一般的意识状态的改变,将HE分为0-4期五个时期(west Haven分期),即从轻微的精神改变到深昏迷,其中0期即为MHE,MHE指肝硬化患者在临床检查没有异常,但出现神经心理学和神经生理学损伤,若MHE不及时干预和治疗,最终有可能发展为OHE。临床上OHE通过症状、体征及血氨等实验室检查诊断并不难,MHE因无神经系统临床表现易漏诊、误诊。MHE目前还没有一个统一的诊断标准,临床上需要敏感性高、特异性强的诊断HE方法,MHE由于缺乏典型的临床表现,只能通过神经生理测验和神经心理测试发现,但会受到年龄、教育程度、学习记忆和不同文化背景、种族及病人合作的影响,不宜单独作为MHE的筛选手段。为了解决这些缺点,Van der Rijt等人提出了脑电图光谱分析,并率先指出光谱分析可作为HE的诊断和预后的指标,因为脑电图不受复杂的教育和文化影响,不受心理评估和病人合作与否的影响,脑电图已被证明是敏感的、独立的HE监测工具。目的:探讨轻型肝性脑病患者脑电图检查的临床价值。材料和方法:对41例轻型肝性脑病患者进行脑电图检查,观察脑电图V监测HE敏感性及特异性。将41例轻型肝性脑病患者按肝功能Child-pugh分级分为A、B、C 3组;并按有无肝性脑病典型的临床体征分为2组;按临床相关指标分为5组,分别与相应EEG进行统计分析。结果:(1)轻型肝性脑病的病因中,肝硬化有36例,占87.80%;(2)41例轻型肝性脑病患者的EEG轻微异常有9例(21.95%),轻度异常有27例(65.85%),中度异常有5例(12.20%);(3)41例轻型肝性脑病患者按肝功能Child-pugh分级分为A、B、C三组,A组8例、B组12例、C组21例,B组与C组差异无显著性,A组与B组、C组之间有显著性差异;(4)AST/ALT比值≥1.2组与1.2组比较脑电图异常差异无显著性;总胆红素≤34.2组与34.2组比较脑电图异常差异无显著性;白蛋白30组与≤30组比较脑电图异常差异有显著性,其中轻微脑电图异常与轻度脑电图异常差异有显著性;(5)PTA80组与≤80组、PTA40组与≤40组比较脑电图异常差异均无显著性;(6)血氨≥60组与60组比较脑电图异常差异无显著性;血氨≥120组与120组比较脑电图异常差异无显著性;(7)有HE临床体征组与无HE临床体征组差异有显著性,其中轻微HE与轻型HE比较脑电图异常差异有显著性。结论:(1)轻微肝性脑病可出现轻微异常脑电图波;(2)脑电图异常程度与肝性脑病分级呈正相关;(3)脑电图检查具有实用性强,操作简便等特点,可以作为轻型肝性脑病的临床诊断工具,可以更广泛应用于临床,提高对轻型肝性脑病尤其是轻微肝性脑病的诊断率。
[Abstract]:Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome. It is characterized by cognition, behavior and dysfunction. It is associated with liver failure and portosystemic shunt. The main manifestations are disturbance of consciousness, abnormal behavior, and coma.HE, which are acute and slow liver diseases, and are fatal complications, such as untimely correction, The pathogenesis of hepatic encephalopathy is currently recognized as ammonia poisoning theory, the formation and metabolism of blood ammonia determine the progression of hepatic encephalopathy, the treatment is mainly to relieve the HE inducement and blood ammonia treatment to achieve clinical cure. According to the patient's mental condition, clinical index and general consciousness change, HE It is divided into 0-4 stages, five periods (West Haven staging), from mild mental change to deep coma, of which 0 is MHE, and MHE refers to cirrhosis patients with no abnormal clinical examination, but neuropsychological and neurophysiological injuries occur. If MHE does not intervene and treat in time, it may eventually develop into OHE. clinical OHE through symptoms, signs and blood. Laboratory diagnosis of ammonia, such as MHE, is not difficult to diagnose. The misdiagnosis of the clinical manifestations of the nervous system is easy to be missed. The misdiagnosed.MHE has not yet a unified diagnostic standard. The diagnostic HE method with high sensitivity and specificity is needed in clinic. Because of the lack of typical clinical manifestations, MHE can only be found by the psychologic test and neuropsychological test. Age, education, learning, memory, and different cultural backgrounds, the influence of race and patient cooperation should not be used alone as a screening tool for MHE. In order to solve these shortcomings, Van der Rijt et al. Proposed the electroencephalogram spectrum analysis, and took the lead to point out that spectral analysis can be used as an indicator of the diagnosis and prognosis of HE because the electroencephalogram is not subject to complex education. The electroencephalogram has been proved to be a sensitive and independent HE monitoring tool. Objective: To explore the clinical value of electroencephalogram in patients with light hepatic encephalopathy. Objective: To explore the clinical value of electroencephalogram examination in patients with light hepatic encephalopathy. Materials and methods: electroencephalogram examination was carried out in 41 patients with light hepatic encephalopathy, and the sensitivity of electroencephalogram V was observed and the sensitivity of HE was observed and the sensitivity of electroencephalogram was observed. Specificity. 41 cases of light hepatic encephalopathy were divided into A, B, and 3 groups according to the liver function Child-pugh classification, and divided into 2 groups according to the typical clinical signs of hepatic encephalopathy, and divided into 5 groups according to the clinical related indexes. Results: (1) there were 36 cases of liver cirrhosis, 87.80%, and 41 cases of light liver disease. (2) 41 cases of light liver. The mild abnormality of EEG in patients with sexual encephalopathy was 9 (21.95%), mild abnormality in 27 cases (65.85%), moderate abnormality in 5 cases (12.20%); (3) 41 cases of light hepatic encephalopathy were divided into A, B, C three, group A, 8 cases, B group 12, C group 21, there was no significant difference between B group and C group, A group and B group, significant difference; 4) ratio There was no significant difference in electroencephalogram abnormalities between the 1.2 groups and the 1.2 groups; the total bilirubin less than 34.2 groups and the 34.2 groups had no significant difference in electroencephalogram. The differences of abnormal EEG differences between the 30 groups and the 30 groups were significant, and the difference between the mild electroencephalogram and the mild electroencephalogram was significant; (5) group PTA80 and < 80, group PTA40 There was no significant difference in electroencephalogram abnormalities between the 40 groups and the 40 groups. (6) there was no significant difference in electroencephalogram abnormalities between the group of blood ammonia > 60 and the 60 groups. There was no significant difference in electroencephalogram abnormalities between the groups of blood ammonia 120 and the 120 groups. (7) there was a significant difference between the HE clinical sign group and the non HE clinical sign group, in which the slight HE and the light HE were compared to the abnormal electroencephalogram. Conclusion: (1) slight abnormal EEG can be found in mild hepatic encephalopathy; (2) the abnormal degree of electroencephalogram is positively correlated with the classification of hepatic encephalopathy; (3) the electroencephalogram examination is practical and easy to operate. It can be used as a diagnostic tool for light hepatic encephalopathy, and can be more widely used in clinic to improve the light liver nature. The diagnostic rate of encephalopathy, especially for mild hepatic encephalopathy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.3

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