The Study On The Diagnostic Value Of Stroop Test In Minimal Hepatic Encephalopathy

ObjectiveTo analyze the influencing factors of the results of Stroop test.To evaluate the value of Stroop test in the diagnosis of the liver cirrhosis with minimal hepatic encephalopathy（MHE）.To preliminarily explore the diagnostic efficacy of Stroop test combined with other neuropsychological tests for MHE.MethodsA total of 185 cirrhotic patients were recruited as the research subjects from the outpatient and inpatient wards of the Department of Infectious Diseases of the Affiliated Hospital of Yan’an University from October 2019 to October 2021 and recorded as the liver cirrhosis group.In addition,277 healthy subjects from our hospital during the same period were selected as the healthy group.Both groups completed number connection test A（NCT-A）,number connection test B（NCT-B）and Stroop test,and the liver cirrhosis group also needed to complete animal naming test（ANT）.1.Analyzing the influencing factors of the results of Stroop test: The demographic information of gender,age and education level of the liver cirrhosis group and the healthy group were collected,and the influencing factors of the results of Stroop test of the above two groups were analyzed by multivariate linear regression.2.The diagnostic value of Stroop test for liver cirrhosis with MHE:With abnormal NCT-A,NCT-B and ANT as the diagnostic criteria for MHE,the liver cirrhosis group was divided into the liver cirrhosis with MHE group and the simple liver cirrhosis group,comparing the test results of the two groups.Receiver operating characteristics（ROC）curve was used to analyze the diagnostic value of Stroop test for MHE.3.The diagnostic efficacy of Stroop test combined with other neuropsychological tests（NCT-A/NCT-B/ANT）for MHE: Pearson correlation analysis was used to analyze the correlation of Stroop test with NCT-A,NCT-B and ANT in all cirrhosis patients respectively.Using ROC curve to analyze the diagnostic value of different diagnostic strategies of Stroop test combined with NCT-A/NCT-B/ANT for MHE.Crosstabs for evaluation of diagnostic tests were established to evaluate the diagnostic performance（sensitivity,specificity,correct rate,positive predictive value,negative predictive value）of Stroop test alone and the above-mentioned different combined diagnostic strategies for MHE.Results1.Analysis of influencing factors of the results of Stroop testMultivariate multiple linear regression analysis showed that in the healthy group,age,education level and gender were all influencing factors for the completion time of Stroop test,among them,age had the greatest influence on it and was positively correlated,education level had a second and negative correlation,while gender had the least effect on the completion time of Stroop test.In the liver cirrhosis group,age and education level were both influencing factors for the completion time of Stroop test,among which age had the greatest influence on it and was positively correlated,education level had a second and negative correlation,while gender had no significant effect.2.Diagnostic value of Stroop test in liver cirrhosis with MHE（1）Compared with the simple liver cirrhosis group,the time of NCT-A,NCT-B and Stroop test in the liver cirrhosis with MHE group were prolonged,and the number of ANT was decreased,and the differences were statistically significant（P<0.05）.（2）The ROC curve analysis showed that the time indicators（Off time,On time and Off time+On time）in Stroop test had good AUC,sensitivity and specificity for diagnosing MHE.Among them,MHE was best identified when the diagnostic critical value of（Off time+On time）was 212.199 s,and the AUC,sensitivity and specificity were0.762（P<0.05）,0.793 and 0.614,respectively.3.Diagnostic efficacy of Stroop test combined with other neuropsychological tests（NCT-A/NCT-B/ANT）for MHE（1）In the liver cirrhosis group,the completion time of Stroop test was positively correlated with the results of NCT-A/NCT-B,but negatively correlated with the results of ANT,and they were all statistically significant.Among them,NCT-A had the strongest correlation with it.（2）The ROC curve analysis showed that the AUCs of different sequence tests of NCT-A/NCT-B/ANT after Stroop test for diagnosing MHE were 0.873,0.834,and 0.845,respectively.Crosstabs analysis showed that compared with Stroop test alone（the value of Off time+On time was 212.199s）,the above combined diagnostic strategy could significantly improve the diagnostic performance of MHE.Among them,Stroop test combined with NCT-A is optimal for the accuracy of diagnosing MHE.Conclusion1.Age and education level were both influencing factors for the completion time of Stroop test in the healthy group and the liver cirrhosis group,and gender had different effects on the test results of the two groups.2.Stroop test has good sensitivity,specificity and AUC for the diagnosis of MHE,and is a simple and effective diagnostic tool for MHE.3.The combination of Stroop test and NCT-A may provide a more effective new strategy for diagnosing MHE for future clinical practice.