数字连接试验对诊断亚临床肝性脑病的价值

·论著·数字连接试验对诊断亚临床肝性脑病的价值

钟碧慧　陈湖　王锦辉　袁育红　胡品津

【摘要】　目的　研究数字连接试验(NCT)的影响因素及其对亚临床肝性脑病(S HE)的诊断价值。

方法　对450例正常人进行NCT检测,探讨影响因素并定出正常参考值范围,与智力检测(IQ)、脑诱

发电位(EP)检查同时应用于40例肝硬化患者,研究其应用价值。结果　(1)NCT值受年龄及文化程

度影响(P<0.001);(2)肝硬化患者NCT异常率为30%(12/40),低于IQ异常率的58%(23/40)(P<

0.01);(3)IQ检查中的木块图、图片排列、图形拼凑及NCT4种方法检查本组肝硬化患者阳性率为

53%,与全套IQ的阳性率(58%)相比,其敏感性为87%,特异性为94%。(4)本组病人S HE的检出率

为85%(34/40)。结论　NCT结果受年龄及文化程度影响,单独应用敏感性低。我们推荐采用IQ检

查中的木块图、图片排列、图形拼凑及NCT4种方法代替全套IQ检查,用于SHE的临床诊断。

【关键词】　肝性脑病;　诱发电位;　数字连接试验

The value of num ber co nnection test in the diagnosis of subclinical hepatic encephalopathy　ZH ONG

Bihui,CHEN Minhu,WA NG Jinhui,et al.Depa rtment o f Gas troenterology,The First A ffiliated H osp ital,Sun

Yat-s en Univer sity of M edical Sciences,G uangzhou,G uangdong510080,China

【Abstract】　Objective　To explore the in fluencing factors and diagnostic values of number connection test

(NCT)in detection of subclinical hepatic encephalopath y(SHE).Methods　NCT was carried out in four hundred

and fifty healthy volunteers to explore the influencing factors and to work out a reference value.Then forty patients

with liver cirrhosis were studied with NCT,intelligence quotient(IQ)and evoked potentials(EP)to determine the

value of NCT in the diagnosis of SHE.Results　(1)NC T results were influenced by age and educational

background.The older the age and the lower the educational level,the longer the NCT time(P<0.001);(2)

The abnormal rate of NCT was30%(12/40),being lower than the IQ abnormal rate of58%(23/40)(P<

0.01).(3)IQ or/and EP were abnormal in85%.(4)The combination of four tests i.e.block design,picture

arrangement,object assembly and NCT were abnormal in53%of the paring with the abnormal rate

(58%)of full set of IQ test,the sensitivity and specificity were87%and94%,respectively.Conclusions　NCT

result was influenced by age and educational background and the sensitivity was low for the scanning of SHE.

Combination of four psychometric tests:block design test,picture arrangement,object assembly and NCT was

recommended to substitute full set of IQ test in the diagnosis of SHE.

【Key words】　Hepatic encephalopathy;　Evoked potential;　Number connection test

亚临床肝性脑病(subclinical hepatic encephalopathy,SHE)是指慢性肝病病人无肝性脑病的临床表现,仅能用精细的智力试验和(或)电生理检查才能诊断的肝性脑病(HE)[1,2]。由于SHE病人存在操作能力低下,从事危险工作有发生事故的隐患,因此,对SHE的研究具有重大的医学和社会学意义,近年来受到国外学者的重视。我国对这方面研究起步较晚,有关报道不多。本研究的目的是探讨数字连接试验(number connection tests,NCT)的影响因素及其对SHE的诊断价值,以寻找适合我国国情的诊断SHE的简便方法。

对象和方法

1.对象:(1)NCT对照组:健康正常人共450例,年龄20～75岁。按年龄分为20～39岁、40～59岁、≥60岁3个年龄段,每个年龄段再按文化程度分为大学、中学及小学3组,共9组,每组50例,男女各半。(2)病例组为1997～1999年住我院的符合第5次全国病毒性肝炎防治方案肝炎肝硬化诊断标准[3]的肝炎后肝硬化患者,共40例,男32例,女8例,年龄27～75岁,平均(51±12)岁。按Child-Pugh 肝功能分级,A级7例,B级15例,C级18例;均无酗酒、HE、神经系统疾病、精神障碍、听力异常等。

2.智商(IQ)检测:采用我国修订的韦氏成人智力量表(WAIS-RC),由广州市精神病院心理科医师操作。W AIS-RC共有11项分测验,其中6项为言语能力测验(常识、领悟、算术、相似性、数字广度、词汇),5项操作能力测验(数字符号、填图、木块图、图片排列、图形拚凑),分别测定言语IQ、操作I Q和全

作者单位:510080广州,中山医科大学附属第一医院消化内科