The Valuation Of Psychometric And Evoked Potentials Tests In Liver Cirrhotic Patients

Objective:Using the psychometric tests,evoked potentials tests, electroencephalogram(EEG),vein blood ammonia and ¹³C-methacetin breath test in liver cirrhotic patients without overt hepatic encephalopathy(OHE).Analysis the results and the clinical significance of these tests in liver cirrhotic patients and diffirent child-pugh classifications.To explore the possible value of tests which can screen minimal hepatic encephalopathy in liver cirrhotic patients without overt hepatic encephalopathy.Methods:1.Chose the sample:Liver cirrhotic patients without current OHE were studied. The patients were divided into Child-pugh A,Child-pugh B and Child-pugh C.The control group were healthy volunteers.2.Meghods:Two groups were accepted the number connection test(NCT),digit symbol test(DST),visual evoked potentials(VEP),brain-stem auditoru evoked potentials(BAEP),short latency somatosensory evoked potentials(SSEP),P300 event-related potentials(P3ERP),EEG,vein blood ammonia,¹³C-methacetin breath test.3.Abnormal:NCT:Higher than((?)+2s)of controls.DST:Lower than((?)-2s)of controls.Evoked potentials(EP):The latency were higer than((?)+2.5s)of controls,the wave amplitude were lower than((?)-2.5s)of controls.The reacting time of P3ERP were higher than((?)+2.5s)of controls.EEG:Above mild unusual brain wave.Vein blood ammonia:Higher than 54umol/l.¹³C-methacetin breath test:Lower than 0.8.4.The statistical analysis was performed using spss 13.0.Result:1.The clinical information:Removing the persons whose age were less than 30 years. The liver cirrhosis group include 114 persons,88 males and 26 females,mean age 55.20±13.10 years.45 patients were classified in Child-Pugh class A,52 in class B,17 in class C.The control group include 86 persons,58 males and 28 females,mean age 54.30±12.59 years.No significant difference was found between the two groups on sex,age,education and others(P＞0.05).2.The influential factors of tests:NCT and DST were influenced by age and education.VEP and BAEP were influnced by age and alcohol intake.SSEP was influnced by sex.P3ERP was influnced by age.3.Comparision of results:Significant differences between two groups were seen in each test including NCT,DST,EP(VEP,BAEP,SSEP,P3ERP),EEG,and ¹³C-methacetin breath test,except vein blood ammonia test(P＜0.01).4.The positive rates in liver cirrhosis:NCT 36.8%,DST 43.0%,VEP 17.5%, BAEP 29.8%,SSEP 38.6%,P3ERP 57.0%,EEG19.3%,vein blood ammonia 3.5% ,¹³C-methacetin breath test 88.6%.The positive rate of psychometric and evoked potentials tests was 76.3%.Significant differences were seen with each other(x² =37.44,P＜0.01).5.The results of tests in three Child-pugh groups:5-1.The positive rate of psychometric and evoked potentials tests was 57.8%in Child-pugh A,86.5%in Child-pugh B,94.1%in Child-pugh C.Significant differences were seen in three groups(x²=14.54,P＜0.01).The positive correlation was found between the positive rate and Child-pugh classifications(r_s=0.35,P＜0.01).The positive rate was increased with the severity of Child-pugh class. 5-2.The positive correlations were found between the positive rates of each test and Child-pugh classifications(P＜0.05),except ¹³C-methacetin breath test(r_s =0.04,P＞0.05).The positive rates of each tests were increased with the severity of Child-pugh class.5-3.The positive correlations was found between the positive numbers of tests and Child-pugh classifications(r_s=0.47,P＜0.01).The more severity of Child-pugh classification,the more tests with positive results.6.The influential factor of abnormality with psychometric and evoked potentials tests in liver cirrhotic patients:Child-pugh classification was a influential factor(B=1.395,p＜0.01).7.The sensitivity and specificity:screen tests of MHEThe positive rate of psychometric and evoked potentials tests was the standard,the sensitivity and specificity of single tests:The specificity of ¹³C-methacetin breath test was 22.2%,the others were 100.0%.The sortation of sensitivity: ¹³C-methacetin breath test＞P3ERP＞DST＞SSEP＞NCT＞BAEP＞EEG＞VEP.DST was better than NCT in psychometric tests.P3ERP was the best in EP,EEG and VEP were the worst. The best united test of two unions was DST+P3ERP(87.4%)and three unions was DST+SSEP+P3ERP(94.3%).Conclusion:1.76.3%liver cirrhotic patients without OHE are abnormal in psychometric and evoked potentials tests,the positive rates of P3ERP and DST are higher.The positive correlations are found between the positive rates and Child-pugh classifications of each test.Child-pugh classification is a influential factor of the liver cirrhotic patients whose psychometric and evoked potentials tests are abnormal.2.The psychometric and evoked potentials tests are influenced by several factors(for example sex,age and alcohol).Stratification analysis of these tests should be used in clinic.3.It may be useful to screen and improve the diagnosis of minimal hepatic encephalopathy that use DST+P3ERP combine with Child-pugh class.