Assessment Of Minimal Hepatic Encephalopathy In Cirrhosis

Objective：To investigate the prevalence and correlative factors of minimalhepatic encephalopathy（MHE）in patients with cirrhosis by using psychometrictests，and assess health-related quality of life (HRQOL)for patients with minimalhepatic encephalopathy.Methods： Number Connection Test-A (NCT-A)and Digit Symbol Test(DST)were carried out in two hundreds and seventy healthy volunteers toexplore the influencing factors such as age and educational background,then towork out a reference value. Seventy-one patients with liver cirrhosis werestudied with NCT-A and DST in the diagnosis of MHE. Collectingexperimental index such as alanine aminotransferase (ALT), aspartateaminotransferase(AST), total bilirubin(TBil)， serum albumin（Alb）, gammaglutamyl transpeptidase （GGT）, alkaline phosphatase(ALP), prothrombintime(PT) and ammonia for every seventy-one patients. Child-Pugh scoreclassification according to liver function，Using CT or B-ultrasound to test ifthey have acites or not.To evaluate health-related quality of life for allseventy-two patients with MHE quality of life scale. Results: Both NCT and DST are influenced by age and educationalbackground.The older the age and the lower the educational level, the longer theNCT and the shoter the DST (P＜0.01);Thirty-two of seventy-one(45.1%)patients were diagnosed to have MHE:5/18in Child A,27/53in Child B and C.The chi-square test showed that patients with more advanced disease(worseChild-pugh class/acites/hyperammonia)seemed to have higher prevalence rate ofMHE(P＜0.05). However,Logistic regression analysis showed that theprevalence of MHE was correlated with ammonnia(P＜0.05),but was notcorrelated with age, acites, Child-Pugh classification,ALT,AST, Tbil,Alb,GGT,ALP and PT in our study(P＞0.05);Compared with non-MHE patients, patientswith MHE had lower HRQOL on the MHE quality of life scale(P＜0.01).Conclusion: Both NCT and DST are influenced by age and educationalbackground, however,they are considered to be simple, reliable and inexpensivemethods for the diagnosis of MHE; Ammonnia plays an important role in theprevalence of MHE, and the prevalence of MHE may be also influenced byacites and Child-Pugh classification;MHE was associated with a decreasedhealth-related quality of life.