| Objective:Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,with high mortality and recurrence rate,which is a serious threat to the life and health of patients.Although ammonia toxicity plays an important role in the occurrence of HE,the mechanism of HE is not completely clear.At present,the diagnosis of HE is mainly based on neuropsychiatric symptoms and neurological examinations.The incidence of HBV-associated cirrhosis is high in China.It is of great significance to analyze risk factors of HBV-associated cirrhosis with HE and to find HE early.This paper analyzed the risk factors of HE in HBV-associated cirrhosis,and discussed the significance of total bilirubin(TBIL),albumin(ALB)combined with serum ammonia detection.It is for guiding clinical practice,avoiding and correcting risk factors of HE,early detection and treatment of HE.Methods:A total of 201 inpatients with HBV-associated cirrhosis who were admitted to the Infectivity Department of Ningxia Medical University General Hospital from January2015 to December 2019 were investigated,including 99 patients in the HE group and 102patients in the non-HE group.Data,including gender,age,platelet(PLT),aspartate transaminase(AST),alanine transaminase(ALT),aspartate aminotransferase-to-platelet ratio index(APRI),neutrophils percentage,TBIL,ALB,serum ammonia and Child grade,were collected and analyzed by SPSS 22.0 software.Normal distribution measurement data in the HE group and the non-HE group were expressed as(?)±s,and t test was used for comparison between the groups.Non-normal distribution measurement data were expressed as median(P25～P75),and z test was used for comparison between the groups.Count data was expressed as example,and x~2test was used for comparison between the groups.Multivariate Logistic regression was used to analyze the independent risk factors for HE in the above-mentioned statistically significant data.ROC curve was used to analyze the value of TBIL,ALB,blood ammonia and combined detection in diagnosis of HE.P<0.05 has statistically significance.Results:Univariate statistical analysis showed that there were significantly different in neutrophils percentage,TBIL,ALB,serum ammonia,and Child grade between HE group and non-HE group(P<0.05).There were no different in gender,age,PLT,AST,ALT,APRI(P>0.05).The neutrophils percentage was 76.9(71.2,79.8)%in HE group,which was significantly higher than 58.2(49.8,66.3)%in non-HE group,with statistical difference(Z=-9.049,P<0.01).The TBIL was 147.3(37.2,374.4)umol/L in HE group,which was significantly higher than 28.3(20.6,49.2)umol/L in non-HE group,with statistical difference(Z=-4.954,P<0.01).ALB was(28.7±4.9)g/L in HE group,which was significantly lower than(31.1±6.2)g/L in non-HE group,with statistical difference(t=3.13,P<0.05).Serum ammonia was 100.0(73.0,146.0)umol/L in HE group,which was significantly higher than41.5(29.0,64.0)umol/L in non-HE group,with statistical difference(Z=-9.459,P<0.01).In the HE group,2 cases(2%)were grade A,39 cases(39.4%)were grade B,and 58 cases(58.6%)were grade C.In the non-HE group,29 cases(28.4%)were grade A,57 cases(55.9%)were grade B,and 16 cases(15.7%)were grade C.The Child grade of HE group was significantly higher than that of non-HE group,and the difference between the two groups was statistically significant(X~2=50.595,P<0.01).The HE group was mainly Child C patients,and the non-HE group was mainly Child B patients.With the increase of Child grade,the number of HE patients increased.Multivariate Logistic analysis showed that low ALB and high serum ammonia were independent risk factors for HE(P<0.05).ROC curve analysis showed that the area under curve(AUC)of TBIL was 0.702 in HE diagnosis.95%Confidence interval(CI)was 0.628-0.776.Cut-off value was 92.815 umol/L(P<0.01).Sensitivity was82.8%.Specificity was 55.9%.Youden index(YI)was 0.387.Positive predict value(PPV)was0.646.Negative predict value(NPV)was 0.770.The AUC of ALB was 0.637 in HE diagnosis.95%CI was 0.56-0.714.Cut-off value was 29.720 g/L(P<0.01).Sensitivity was 69.7%.Specificity was 60.8%.YI was 0.305.PPV was 0.633.NPV was 0.674.The AUC of serum ammonia was 0.886 in HE diagnosis.95%CI was 0.841-0.931.Cut-off value was 67.500umol/L(P<0.01).Sensitivity was 77.6%.Specificity was 71.2%.YI was 0.561.PPV was0.752.NPV was 0.723.The AUC of combined detection was 0.891 in HE diagnosis.95%CI was 0.847-0.935(P<0.01).Sensitivity was 80.8%.Specificity was 82.4%.YI was 0.632.PPV was 0.819.NPV was 0.794.These results suggested that combined detection has higher diagnostic value for HE than detection of TBIL,ALB and serum ammonia alone.The diagnostic value of serum ammonia was higher than that of TBIL and ALB.The most sensitive indicator for the diagnosis of HE was TBIL.The biggest of specificity,YI,PPV and NPV was combined detection.Conclusion:1.The increase of TBIL and serum ammonia,the decrease of ALB,the increase of neutrophils percentage and the increase of Child grade can easily lead to HE in patients with HBV-associated cirrhosis.2.Low ALB and high serum ammonia are independent risk factors for HBV-associated Cirrhosis with HE.3.TBIL,ALB combined with serum ammonia detection are of great significance in the diagnosis of HBV-associated cirrhosis with HE. |
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