Minimal Hepatic Encephalopathy In Liver Cirrhosis Patients:Early Diagnosis, Assessment Of The Quality Of Life

[Objectives]1、To investigate the prevalence and analyse the correlative factors of minimal hepatic encephalopathy (MHE) in liver cirrhosis patients without overt hepatic encephalopathy (OHE).2、To evaluate the value of psychometric test and brainstem auditory evoked potentials (BAEP) in the early diagnosis of MHE for liver cirrhosis patients without OHE.3、To assess the quality of life (QOL) for the cirrhosis patients with MHE.[Methods]1、Forty-four liver cirrhosis patients without OHE were studied. Collecting the patients’ general and experimental data. Using CT or B-ultrasound to test if they have ascites or not. Child-Pugh grade according to HE or not, ascites or not, prothrombin time, liver function date (albumin and total bilirubin). All patients underwent psychometric test and BAEP, psychometric test including number con nection test-A (NCT-A) and digit symbol test (DST).2、To assess QOL for all forty-two liver cirrhosis patients with the QOL. The QOL scale for patients with MHE consists of five domains (thirty items) which contains physical, psychological, symptoms, social and general-health domain scale.[Results]1、MHE could be found in65.9%(29/44) of the patients with liver cirrhosis groups in the study. Patients were ranked by liver function according to Child-Pugh grade and with the increasing of Child-Pugh grade, the prevalence rate of MHE also increased:Child-Pugh grade A patients have36.4%(4/11), grade B patients have69.2%(9/13), and grade C patients have80.0%(16/20), respectively. There was a significant difference between Child-Pugh grade A and C(P<0.01), A and B(P<0.05). There was no difference between Child-Pugh grade B and C(P>0.05).2、In the forty-four patients with liver cirrhosis, the total abnormal rate of psychometric test was52.3%, the abnormal rate of NCT-A+DST was the highest (31.8%) in the three kinds of psychometric test, which was much higher than of BAEP(34.1%). In the twenty-nine diagnosed patients with MHE, nine patients (31.0%) was abnormal in both psychometric test and BAEP, fourteen patients (48.3%) was abnormal only in psychometric test, and six patients (20.7%) was abnormal only in BAEP.3、There was a difference of BA level as compared with those in the patients with MHE and non-MHE which based upon the abnormal rate of psychometric test(P<0.05). There was also a difference of BA level as compared with those in the patients with MHE and non-MHE which based upon the abnormal rate of BAEP(P<0.05), but BA level in the patients with MHE was higher than in non-MHE. There was no difference of BA level as compared with those in the patients with MHE and non-MHE which based upon the abnormal in both psychometric test and BAEP(P<0.05).4、Logistic regression analysis showed that there was a close relationship between the MHE prevalence and he blood ammonia(BA), hyponatremia(P<0.05) and Child-Pugh grade(P<0.01), and no relationship had been found between the MHE prevalence and other factors including gender, age, education, PT, ALB, ALT, AST, γ-GT and ALP(P>0.05).5、There was a difference of the QOL score was compared with those in the patients with MHE and non-MHE(P<0.05). The QOL score was related to Child-Pugh grade, and patients who were Child-Pugh grade C had higer scores of QOL, which reflected worse QOL than other two grades.6、The Spearman rank correlation test show that Physical, Psychological, Symptoms, General-health domain scores and total scores had a positive correlation with NCT-A except Social-health domain scores(P>0.05) for assessing their QOL. The test found a negative correlation between DST and Physical, Psychological, Symptoms, General-health domain scores and total scores. The test also found there had a positive correlation between BAEP and Physical, Psychological, Symptoms-health domain scores.[Conclusions]1、MHE could be found in64.3%of the cirrhosis patients without OHE in the study. The prevalence rate of MHE was correlated with the severity of liver cirrho-sis.2、Psychometric test was more sensitive than BAEP measurement for the diagnosis of MHE due to liver cirrhosis. At the same time, psychometric test and BAEP were not overlapped completely but complemented each other. There was added advantage of performing two kinds of psychometric test and BAEP for the detection of MHE which help to supply the basis for early diagnosis on MHE high-risk groups.3、BA level was not the standard in diagnosing MHE, but it might be related to the occurrence of MHE due to liver cirrhosis to a certain extent.4、The QOL for patients with MHE was declined. And the tendency of decrea-se consistented with the degree of liver malfunction. Much of the QOL score correlated significantly with NCT-A, DST and the latency of BAEP.5、The QOL scale for patients with MHE is a valid, practical and reliable method for testing MHE in patients with liver cirrhosis.