轻微型肝性脑病(minimal hepatic encephalopathy, MHE)是肝性脑病发病过程中的一个早期阶段,隐匿性强,仅能通过特殊的神经心理学测试或神经生理学检查才能识别出来,临床漏诊率高。MHE会影响患者与健康相关的生活质量、驾驶能力、社会经济地位等方面,因此,早期诊断MHE并及时给予患者有效的临床干预至关重要。MHE的诊断方法有很多,主要包括神经心理学测试、神经生理学检查和影像学检查,现就国内外MHE的诊断方法研究进展作一综述,从而提高对不同诊断方法的认识。
Minimal hepatic encephalopathy (MHE) is an early stage in the pathogenesis of hepatic encephalopathy. It is highly concealed and can only be identified through special neuropsychological tests or neurophysiological examinations, and the rate of clinical missed diagnosis is high. MHE can affect the health related quality of life, driving ability, socioeconomic status and other aspects of patients. Therefore, it is very important to diagnose MHE early and give patients effective clinical intervention in time. There are many diagnostic methods for MHE, mainly including neuropsychological tests, neurophysiological examinations and imaging examinations. This article reviews the research progress of domestic and abroad MHE diagnostic methods, so as to improve the understanding of different diagnostic methods.
Minimal hepatic encephalopathy (MHE) is an early stage in the pathogenesis of hepatic encephalopathy. It is highly concealed and can only be identified through special neuropsychological tests or neurophysiological examinations, and the rate of clinical missed diagnosis is high. MHE can affect the health related quality of life, driving ability, socioeconomic status and other aspects of patients. Therefore, it is very important to diagnose MHE early and give patients effective clinical intervention in time. There are many diagnostic methods for MHE, mainly including neuropsychological tests, neurophysiological examinations and imaging examinations. This article reviews the research progress of domestic and abroad MHE diagnostic methods, so as to improve the understanding of different diagnostic methods.
可重复性成套神经心理状态测验(repeatable battery for the assessment of neuropsychological status, RBANS)主要用于对5个认知功能领域进行评估:即刻记忆、空间结构、注意力、言语功能及延迟记忆。RBARS作为认知功能损害的筛查工具,既可鉴别老年人认知功能的病理性下降,也可筛查一般人群的神经心理功能状态,现已广泛应用于不同人群的认知功能测评,目前,RBANS已在美国建立基于正常人群的规范参考数据,用于阿尔茨海默氏病和精神分裂症等多项临床试验 [12] [13],并翻译成多种语言供临床和科研工作使用。RBANS以其拥有大量在评估多种疾病引起的认知功能障碍方面的临床有效性数据的优势,被ISHEN实践指南 [6] 推荐作为检测MHE的金标准。
随着MRI技术的发展,对HE的诊断评价不再仅局限于大脑的解剖结构,多种功能磁共振成像(functional magnetic resonance imaging, fMRI)技术发展起来,使研究大脑组织物质代谢变化、脑组织内水分子的扩散情况、更加精确显示脑组织形态学变化、反映脑组织内的血流灌注和微血管分布情况成为可能,为疾病诊断提供更为准确的影像学依据。
李培燕,高晓红,彭 芳. 轻微型肝性脑病的诊断方法研究进展Research Progress in the Diagnosis of Minimal Hepatic Encephalopathy[J]. 临床医学进展, 2021, 11(02): 669-676. https://doi.org/10.12677/ACM.2021.112097
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