| Objective:The clinical symptoms and signs of minimal hepatic encephalopathy（MHE）are not obvious and are easily overlooked clinically.In this study,MHE was analyzed and summarized to explore the relevant risk factors for the incidence of MHE.In order to improve the clinician’s understanding of MHE and provide clinical ideas for the early diagnosis of mild hepatic encephalopathy.Methods:The inpatients who were diagnosed with liver cirrhosis in the Department of Hepatobiliary and Pancreatic Medicine,Second Hospital of Jilin University from November 2020 to November 2021 were selected as the research subjects,and the general data,clinical data and other data of each patient were collected respectively.MHE patients were screened by NCT-A and DST tests.When both results were positive,MHE was diagnosed.According to the screening results,the included subjects were divided into MHE group and non-MHE group.Completion of NRS2002,RFH-NPT,PSQI score and Encephal App Stroop test.SPSS25.0 statistical software was used for statistical analysis,t test,2 test,nonparametric rank sum test and binary Logistic regression analysis were used to analyze the risk factors affecting the occurrence of MHE;ROC curve was used to analyze the off time,The detection efficiency of on time and off+on time was determined to determine the critical value for diagnosing MHE,as well as the sensitivity and specificity under the critical value,and calculate the positive predictive value and negative predictive value,so as to clarify the diagnostic value of Encephal App Stroop test for MHE.Results:1.A total of 151 patients with liver cirrhosis were included in this study,and they were grouped according to the screening results of NCT-A and DST tests,including 60patients（39.74%）in the MHE group and 91 patients（60.26%）in the non-MHE group.There were no significant differences in gender,age,etiology,ethnicity,smoking history,hypertension history and diabetes history between the two groups（P>0.05）.2.The levels of NLR,Hp,WBC,hs-CRP,Hb,PLT,CHE,SCr in the MHE group and the non-MHE group were not statistically significant（P>0.05）.The levels of ALB and PTA in the MHE group were lower.In the non-MHE group,the scores of TBIL,INR,PT,Cys C,and MELD were higher than those in the non-MHE group,and the difference was statistically significant（P<0.05）.In the Child-Pugh classification of liver function,the proportion of Child-Pugh A,B and C patients in the MHE group accounted for 16.7%,36.7%,and 46.7%,respectively,suggesting that the higher the Child-Pugh classification,the higher the incidence of MHE.The difference was statistically significant（P<0.05）.The proportions of nutritional risk and sleep disturbance in the MHE group were higher than those in the non-MHE group,and the difference was statistically significant（P<0.05）.3.The statistically significant indexes were included in binary logistic regression analysis,and the results showed that Child-Pugh grade C（OR=0.233,P<0.05）,MELD score（OR=1.131,P<0.05）and PT（OR=1.303）,P<0.05)was an independent risk factor for liver cirrhosis complicated with MHE.4.Diagnostic value of the Encephal App Stroop test（1）.The results of the Encephal App Stroop test in the MHE group and the non-MHE group were analyzed and compared,and the results showed that the two groups had statistical differences in Off time,On time and Off time+On time（P<0.05）.（2）The AUC of Off-time diagnosis of MHE was 0.842（P<0.001）,the best critical value was 85.5s,the sensitivity and specificity were 0.82 and 0.81,respectively;the AUC of On-time diagnosis of MHE was 0.824（P<0.001）,the best critical value was103.5s,the sensitivity and specificity were 0.87 and 0.69,respectively;the AUC of Off time+On time for the diagnosis of MHE was 0.837（P<0.001）,the optimal critical value was 189.5s,and the sensitivity and specificity were 0.85 and 0.71,respectively.Conclusion:1.Child-Pugh grade,MELD score,TBIL,ALB,Cys C,PT,INR,PTA,nutritional risk,sleep disturbance are risk factors for liver cirrhosis with MHE,among which Child-Pugh grade C,MELD score and PT are liver Independent risk factors for cirrhosis and MHE.2.The Encephal App Stroop test takes Off time+On time>189.5s as the cutoff value,which has good sensitivity and specificity,and can be used to screen MHE and achieve early diagnosis. |
PDF Full Text Request