Covert Hepatic Encephalopathy: Does the Mini-Mental State Examination Help?
Covert Hepatic Encephalopathy: Does the Mini-Mental State Examination Help?
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DOI：
10.1016/j.jceh.2013.12.005
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发表时间：
2014-06-01
影响因子：
3
通讯作者：
Montagnese, Sara
中科院分区：
文献类型：
--
作者：
Corrias, Michela;Turco, Matteo;Montagnese, Sara
背景/目的：简易精神状态检查（MMSE）已用于诊断肝性脑病（HE）。然而，其异常阈值尚未在肝硬化患者中进行正式测试，其诊断/预后有效性仍然未知。本研究的目的是在一大群特征良好的肝硬化门诊患者中评估它，没有明显的HE。研究方法：191名患者接受了临床评估、简易智能状态检查（MMSE）、脑电图（EEG）和纸笔心理测量（PHES）; 117名患者接受了8 +/- 5个月的随访，以了解HE相关住院的发生情况。结果：在研究当天，81例（42%）患者有异常EEG和67例（35%）异常PHES; 103例（60%）有HE病史。平均MMSE为26.6 +/- 3.5;根据标准阈值24，22例（19%）患者MMSE异常。EEG/PHES异常/HE病史患者的MMSE表现比检查正常/病史阴性的患者差（分别为25.7 +/- 4.2 vs. 27.3 +/- 2.7; P < 0.01; 25.5 +/- 3.2 vs. 27.9 +/- 1.8，P < 0.0001; 26.3 +/- 3.7 vs. 27.4 +/- 2.6，P < 0.05）。基于上述结果，针对临床/EEG/PHES指标的异常测试MMSE阈值26和27，并观察到显著关联。MMSE阈值26也是HE相关住院的预测因子（Cox-Mantel：P = 0.001）; MMSE< 26的患者明显比MMSE <26的患者年龄大，但在肝功能障碍和氨水平方面具有可比性。当MMSE项目被单独考虑时，那些与标准HE指数相关最显著的项目是空间定向和书写。结论：总之，MMSE < 26识别出更容易表现出HE体征的老年肝硬化患者。
Background/objectives: The Mini-Mental State Examination (MMSE) has been utilized for the diagnosis of hepatic encephalopathy (HE). However, its threshold of abnormality has not been formally tested in patients with cirrhosis and its diagnostic/prognostic validity remains unknown. The aim of this study was to assess it in a large group of well-characterized outpatients with cirrhosis and no overt HE. Methods: One-hundred-and-ninety-one patients underwent clinical assessment, MMSE, electroencephalography (EEG) and paper-and-pencil psychometry (PHES); 117 were followed up for 8 +/- 5 months in relation to the occurrence of HE-related hospitalizations. Results: On the day of study, 81 patients (42%) had abnormal EEG and 67 (35%) abnormal PHES; 103 (60%) had a history of HE. Average MMSE was 26.6 +/- 3.5; 22 (19%) patients had abnormal MMSE based on the standard threshold of 24. Patients with abnormal EEG/PHES/history of HE had worse MMSE performance than their counterparts with normal tests/negative history (25.7 +/- 4.2 vs. 27.3 +/- 2.7; P < 0.01; 25.5 +/- 3.2 vs. 27.9 +/- 1.8, P < 0.0001; 26.3 +/- 3.7 vs. 27.4 +/- 2.6, P < 0.05, respectively). Based on the above results, MMSE thresholds of 26 and 27 were tested against abnormalities in clinical/EEG/PHES indices and significant associations were observed. An MMSE threshold of 26 was also a predictor of HE-related hospitalization (Cox-Mantel: P = 0.001); patients with MMSE< 26 were significantly older than those with MMSE$ 26 but comparable in terms of liver dysfunction and ammonia levels. When MMSE items were considered separately, those which correlated most significantly with standard HE indices where spatial orientation and writing. Conclusion: In conclusion, an MMSE < 26 identifies older patients with cirrhosis who are more prone to manifest HE signs.