Value of the critical flicker frequency in patients with minimal hepatic encephalopathy
Value of the critical flicker frequency in patients with minimal hepatic encephalopathy
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DOI：
10.1002/hep.21586
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发表时间：
2007-04-01
期刊：
影响因子：
13.5
通讯作者：
Felipo, Vicente
中科院分区：
文献类型：
--
作者：
Romero-Gomez, Manuel;Cordoba, Juan;Felipo, Vicente
轻微肝性脑病（MHE）主要使用心理测量测试进行诊断，如心理测量肝性脑病评分（PHES）。尽管MHE具有临床和社会相关性，但心理测量测试在常规临床护理中并不普遍。我们评估了临界闪烁频率（CFF）的有用性，用于MHE的诊断和HE明显发作的发展的预测。在对照组中评价西班牙人群PHES的正常范围。随后，114名肝硬化患者和103名健康对照者接受了PHES和CFF试验。当PHES低于-4分时，诊断为MHE。患者每6个月随访一次，共随访1年。在对照组中，CFF与年龄、教育程度或性别无关。MHE患者的平均CFF显著低于非MHE或对照组。平均CFF与个人心理测验以及PHES相关（r = 0.54; P < 0.001）。CFF < 38 Hz预测进一步发作的明显HE（对数秩：14.2; P < 0.001）。平均CFF与Child-Pugh评分之间存在弱相关性，但与终末期肝病评分模型无关。在多变量分析中，使用考克斯回归，CFF与Child-Pugh评分是独立的发展明显的HE。结论：CFF是诊断MHE的一种简便、可靠、准确的方法。它不受年龄和受教育程度的影响，可以预测显性HE的发展。
Minimal hepatic encephalopathy (MHE) is mainly diagnosed using psychometric tests such as the psychometric hepatic encephalopathy score (PHES). Despite the clinical and social relevance of MHE, psychometric testing is not widespread in routine clinical care. We assessed the usefulness of the critical flicker frequency (CFF), for the diagnosis of MHE and for the prediction of the development of overt episodes of HE. The normal range of PHES in the Spanish population was evaluated in a control group. Subsequently, 114 patients with cirrhosis and 103 healthy controls underwent both PHES and CFF tests. A diagnosis of MHE was made when the PHES was lower than -4 points. Patients were followed-up every 6 months for a total of I year. CFF did not correlate with age, education, or sex in the control group. The mean CFF was significantly lower in patients with MHE versus non-MHE or controls. Mean CFF correlated with individual psychometric tests as well as PHES (r = 0.54; P < 0.001). CFF < 38 Hz was predictive of further bouts of overt HE (log-rank: 14.2; P < 0.001). There was a weak correlation between mean CFF and Child-Pugh score but not with model for end-stage liver disease score. In multivariate analysis using Cox regression, CFF together with Child-Pugh score was independently associated with the development of overt HE. Conclusion: CFF is a simple, reliable, and accurate method for the diagnosis of MHE. It is not influenced by age or education and could predict the development of overt HE.