| Objective:To investigate the correlation between the presence of minimal hepatic encephalopathy (MHE) and levels of venous ammonia and serum inflammatory cytokines in cirrhotic patients as well as the interaction of ammonia and inflamma-tory cytokines in the presence of MHE and cognitive function impairment of MHE patients.Methods:1. According to the included and excluded criteria, a total of75cirrhotic patients were recruited in the study, and liver cirrhosis was diagnosed by liver func-tion tests, ultrasonic inspection, imageology or biopsy. Included patients were screened for MHE using a battery of psychometric tests including number connection test A (NCT-A) and digit symbol test (DST). MHE was diagnosed when the results of both NCT-A and DST presented abnormal.2. Demographic characteristics, results of biochemical and coagulation examinations, and levels of inflammatory markers were analyzed using Student’s t-test or chi-square test between MHE and non-MHE patients. The significantly different factors in the univariate analyses were included in a multivariate logistic regression analysis in or-der to indentify the risk factors of MHE. The receiver operating characteristic (ROC) curves were applied to calculate the cut-off values of these risk factors.3. Investigating the correlation between the risk factors of MHE and the results of NCT-A and DST in order to determine the correlation between these factors and cog-nitive function impairment in cirrhotic patients with MHE.4. According to the cut-off values of the risk factors,75cirrhotic patients were di-vided into groups. The chi-square test and variance analysis were performed to inves-tigate the interaction of these factors in the presence of MHE and cognitive function impairment of MHE patients.Results:1. In75cirrhotic patients,37patients (49.3%) have abnormal results of NCT-A, and32patients (42.7%) have abnormal results of DST. In total,22patients (29.3%) have abnormal results in both NCT-A and DST, and they were diagnosed with MHE.2. Compared with non-MHE patients, venous ammonia (t=3.389, P<0.001), Child-Pugh score (t=2.029, P=0.028), TNF-a(t=2.194, P=0.015), and IL-6(t=5.148, P<0.001) were significantly higher in the MHE patients. Venous ammonia (OR=15.675,95%CI:4.146-58.665) and TNF-a (OR:8.796,95%CI:3.836-20.574) were the risk factors of MHE, and their cut-off values were21.5μmol/L and32.1pg/ml, respectively.3. In the MHE patients, the levels of venous ammonia were correlated with the results of NCT-A (r=0.493,P=0.019) and DST (r=-0.415, P=0.028).The levels of TNF-a were associated with the results of NCT-A (r=0.640, P=0.001).4. The prevalence of MHE in the cirrhotic patients with high levels of venous ammo-nia and TNF-a was significantly higher than that of patients with only high levels of venous ammonia (χ2=3.640, P=0.045) and TNF-α (χ2=5.235, P=0.011), respectively. The results of NCT-A in the cirrhotic patients with high levels of venous ammonia and TNF-a were significantly higher than that of patients with only high levels of ve-nous ammonia (q=3.192, P=0.036) and TNF-a (q=2.235, P=0.041), respectively. The results of DST in the cirrhotic patients with high levels of venous ammonia and TNF-a were significantly higher than that of patients with only high levels of venous ammonia (q=3.647, P=0.022).Conclusion:Venous ammonia and serum TNF-a are the risk factors of MHE, and levels of them are correlated with the presence of MHE and cognitive function im-pairment of MHE patients. Venous ammonia and TNF-a have the synergistic effect in the presence of MHE and cognitive function impairment of MHE patients. And the levels of both variables significantly correlate with the severity of HE. Moreover, plasma ammonia levels are associated with serum TNF-a levels. These results indi-cate that TNF-a may be involved in the pathogenesis of HE, and that TNF-a may have a po-tential synergistic interaction with ammonia in the pathogenetic mechanism of HE. |
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