A Clinical Analysis Of 107 Cases Of Hepatic Encephalopathy

Objectives:Hepatic encephalopathy, resulted from a complication of acute and chronic liver failure, is a disturbance in central nervous system function. According to the degree of conscious impairment, nervous system manifestation and electroencephalogram (EEG) changes, HE can be divided into four parts from the slight mental changes to deep coma. There is no definitely boundary between each two of the stages, and same clinical manifestations may exist in different stages, which are affect by subjective factors. Although HE takes liver failure as its underlying diseases, some patients at first go to Neurology Department because of the disturbance of central nervous system function. This paper makes a retrospective analysis, and attaches main attention to the relations between related factors and clinical stages in order to further understand the characteristics of HE, which would be of great help to the diagnosis of HE.Objective and methods:To study 107 clinical cases with the diagnosis of hepatic encephalopathy admitted between 2004.1 and 2011.1 in 1st hospital of Jilin University, this paper made a retrospective analysis of the patients on the standard of HE Davidson, dividing the clinical cases into four stages. The paper did a contrastive research on the data analysis of sex, age, etiology, precipitating factors, related biochemical indicator and different prognosis, and tried to discuss their correlation with HE stages and analyze the clinical characteristics of HE cases who first go for diagnosis in Neurology Department.For 107 patients with the diagnosis of HE in this group, the grade of HE wasⅠin 17 patients (male 12cases, female 2 cases),Ⅱin 46 (male 30 cases, female 16 cases),Ⅲin 18 (male 14 cases, female 12 cases) andⅣin 26 (male 14 cases, female 12 cases). Although male patients (64.5%) were more than female patients (35.5%), there were no significant differences(p>0.05) in the stage of HE.The youngest patient was 30 years old while the oldest one was79 years old, and the average age was 56.79±11.94 ys. The group of 50～64 years old (41.12%) took higher ratio than the group above 65 years old(31.78%) and the group below 50 years old(27.1%). There were no significance in He Stage. (p>0.05)The basic etiology contained hepatitis cirrhosis (79 cases), in which hepatitis B was in 58 cases, hepatitis C was in 21 cases and both types of hepatitis were in 2 cases, alcoholic liver cirrhosis (22 cases), primary liver cancer (11 cases), hepatitis cirrhosis companied by alcoholic cirrhosis (7 cases), hepatitis cirrhosis companied by primary liver cancer (7 cases), and other factors resulting in pathology (13 cases), The most common one in basic etiology was seen in hepatitis cirrhosis, which was the main etiology of HE.HE was caused by various precipitating factors, including gastrointestinal bleeding (22 cases), infection (47 cases), high protein-diet uptake (23 cases), diarrhea and constipation (11 cases), other precipitating factors (16 cases)and unclear factors (24 cases). Single precipitating factor was in 29 cases, mutil-precipitating factors were in 54 cases. Various precipitating factors, single precipitating factor and mutil-precipitating factors had no statistic differences in HE stages.15 patients went first to Neurology Department for treatment, of which 5 patients had had underlying liver diseases. Their type of onset manifested in such way: general fatigue and stagger (4 cases),lethargy, consciousness change (5 cases), paroxysmal twitch (3 cases), abnormal behavior and mental symptom (2 cases), and language barriers (2 cases). They were all admitted as the diagnosis of Encephalitis or cerebrovascular disease The characteristics of the lab testing results in group differences between different HE stages had significance (p<0.05), and the value of AST, TBIL, PT, BUN, and Cr all raised with the increasing HE stage, while the values of ALT, Alb, HBG, and Na+ went the opposite. Respectively compared with stageⅠ, stageⅢand stageⅣ, index in stageⅡshowed distinct significance (p<0.05), and index in stageⅢhad no statistic significance in contrast to that in stageⅣ.For the patients with the diagnosis of HE, there are 11 patients with poor prognosis of 17 clinical cases in StageⅠ,11 of 46 patients in StageⅡ,6 of 6 patients in StageⅢ, and 15 of 26 patients in StageⅣ. It showed that the higher the stage was, except gradeⅠ, the worse the poor prognosis became.There are 17 patients with the diagnosis of HE companied by diabetes, among which 4 patients were inⅠ,6 inⅡ,2 inⅢand 5 inⅣ. There existed no statistic significance between companied diabetes and HE stages.Conclusion:Compared with female patients, the majority of patients with the diagnosis of HE are seen in male, taking the period of middle and elder age as HE peak. The basic etiology of HE mainly results from liver cirrhosis, in which hepatitis cirrhosis is the main factor. HE was usually companied with precipitating factors, and the common ones were gastrointestinal bleeding, infection, high protein-diet uptake, and diarrhea and constipation. Infection laid the highest ratio in the precipitating factors mentioned above, and mutil-precipitating factors caused HE pathology in some patients. The research in this group showed that the higher the stage (except stageⅠ) was, the worse the prognosis was. The data (sex, age, underlying causes, precipitating factors and diabetes) had no distinct differences on probability distribution in different HE stages. Laboratory test results in group differences between different HE stages had significance (p<0.05), and the value of AST, TBIL, PT, BUN, and Cr all raised with the increasing HE stage, while the values of ALT, Alb, HBG, and Na+ went the opposite. Respectively compared with stageⅠ, stageⅢand stage Ⅳ, index in stageⅡshowed distinct significance (p<0.05), and index in stageⅢhad no statistic significance in contrast to that in stageⅣThe onset forms of HE are various, and there has been no special treatment to HE by far. Different prognosis exists in different stage. To have a full diagnosis and evaluation of the characteristics of HE stage is of great importance to the prevention of HE development.