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1、 _ _ R575.5 _ _ _ _ _ _ 10760 _ _ 200506100301411 新 疆 医 科 大 学 X i n J i a ng M e d i c a l U n i v e r s i t y 硕士学位论文 T H E S I S O F M A S T E R D E G R E E 临 床 医 学 专 业 学 位 (学历教育) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( _ _ _ ) _ _ _ 2011 _ 4 _ -2011 _ 10 _ _ _ 2012 _ 04 _ _ _ _ _
2、 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( _ _ _ ) _ _ _ _ _ 2012 _ 04 _ _ Critical flicker frequency and PHES for the diagnosis of minimal hepatic encephalopathy _ Dissertation Submitted to Xinjiang Medical University In Partial Fullfillment of the Requirements for the Degree of Master of Medicine By Wang
3、Yue Internal Medicine(Gastroenterology) Dissertation Supervisor: Prof.He Fangping April,2012 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( _ _ / _ _ _ ) _ _ _ 1. _ _ _ _ _ _ _ _ _ _ _ _
4、_ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ ( _ _ ) _ _ _ _ _ _ CNKI _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MHE Minimal Hepatic Encephalopathy _ _ _ SHE Subclinic Hepatic Encephalopathy _ _ _ _ PHES Psychometric Hepatic Encephalopathy Score _ _ _ _ _ CFF Cri
5、tical Flicker Frequency _ _ _ NCT-A Number Connection Test-A, _ _ _ LTT Line Traing Test _ _ _ _ _ _ _ 1 ABSTRACT 2 _ 4 _ _ _ 5 1. _ _ _ 5 2. _ _ _ 6 2.1 _ _ _ 6 2.2 _ _ _ _ 6 2.3 _ _ _ 6 2.4 _ _ _ 7 3. _ _ _ 8 _ 9 _ 11 _ 19 _ 20 _ _ _ 21 _ 25 _ 29 _ _ _ _ _ _ _ 36 _ _ _ 37 _ _ _ 1 _ _ _ _ _ _ _ _ _
6、 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Minimal Hepatic Encephalopathy MHE) _ _ _ _ _ _ _ _ _ _ _ 2011 _ 4 _ 2011 _ 10 _ _ _ 121 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Psychometric Hepatic Encephalopathy Score PHES) _ (Critical Flicker Frequency CFF) _ _ _
7、 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 121 _ _ _ 33.9%(41 _ _ ) _ _ 42.2%(51 _ ) _ 82.0%CFF _ PHES _ _ 67.2% _ PHES _ CFF _ _ 41.3%(50 _ )CFF _ _ 39 Hz _ MHE_ 50.4%(61 _ ) _ PHES _ _ -4 _ MHE _ _ _ _ 23.9% _ _ (P _ 0.61_ 0.05) _ _ MHE _ _ 70 _ (57.85%) _ _ _ MHE _ _ Child-pugh
8、_ _ _ _ _ _ _ Logistic _ MHE _ MHE _ _ Child-pugh _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MHE _ _ _ _ _ Child-pugh _ _ _ _ _ _ _ _ _ _ _ 2 Critical flicker frequency and PHES for the diagnosis of minimal hepatic encephalopathy Postgraduate: Yue Wang Supervisor: Prof. He Fangping Abstract Objective: The aim of
9、 this study was to assess the morbidity of Minimal Hepatic Encephalopathy (MHE) in cirrhosis patients. Compared two psychometric methods of testing MHE. Then to explore the potential risk factors of MHE based on cirrosis in Xinjiang. Methods: We compared two easy-to-perform reproducible bedside. Met
10、hods: the critical flicker frequency (CFF) and Psychometric Hepatic Encephalopathy Score (PHES) for Identifying Patients with Minimal Hepatic Encephalopathy.The study conducted at the Hepatology Department of First Affiliated Hospital of Xinjiang Medical University.121 cirosis patients were selected
11、, who were with out overt hepatic encephalopathy (HE) underwent both tests at the same occasion. A CFF _ 39 Hz and PHES-index _ -4 indicates cerebral dysfunction.These patients were test the blood ammonia concentration and liver function grading. Results: Both tests were abnormal in 33.9% of the pat
12、ients and both tests were normal in 42.2% of the patients. In more than 2/3 the two tests were in agreement as CFF classified 41.3% and PHES scale classified 50.4% of the patients as having MHE. The two tests were well linearly correlated (P _ 0.05) and neither test correlated with the liver functio
13、n, nor with the blood ammonia concentration, age, gender, cultural degree, causes of liver disease.Both tests identified a large fraction of the patients as having MHE (57.85%). The two tests show concordant results. Muitivariate analysis confirmed that age growing is the risk factor of MHE.But bloo
14、d ammonia concentration, gender, cultural degree, causes of liver disease, liver function level were not significantly different between MHE patients and patients without MHE. Conclusion: There are a large fraction of the patients as having MHE. Both of the two reproducible bedside methods are easy-
15、to-perform to identifying patients with Minimal Hepatic Encephalopathy. Logistic muitivariate analysis showed significant difference in age growing. Other factors were not significantly different between MHE _ _ _ 3 patients and patients without MHE. Key words: Minimal hepatic encephalopath; Cirosis
16、; Critical flicker frequence _ _ _ 4 _ _ _ (Minimal Hepatic Encephalopathy) _ (Subclinical Hepatic Encephalopathy _ SHE)_ “ _ ” _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ 0_ 4 _ _ 0 _ 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MHE _ _ 1 _ _ _ _ _ 3,4 _ _ 50%
17、 _ MHE _ _ _ _ _ _ _ _ _ _ _ _ _ MHE _ _ _ _ _ _ _ _ _ MHE _ _ 25% _ 84% _ 3,4 _ _ _ _ (CFF) _ _ _ _ _ _ _ _ Kircheis 5 _ _ _ CFF _ _ MHE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MHE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5 _ _ _ _ 1 _ _
18、_ _ 2011 _ 4 _ 2011 _ 10 _ _ _ 121 _ 86 _ 35 _ 22_ 81 _ (51.5 _ 3.53) _ _ _ 1.1 _ _ _ 2000 _ _ _ _ 1) _ x _ _ _ _ 2)B _ _ _ _ _ _ _ _ _ 1.4cm _ _ _ _ 1.0cm _ 3) _ _ _ _ 4)CT _ / _ _ 0.05_ _ _ 5) _ _ _ _ _ _ _ _ _ _ _ _ 5) _ _ _ _ _ _ _ _ _ _ 1) _ (A/G _ _ A _ _ rG _ _ _ ) _ _ (HA) _ _ _ _ (P _ P) _
19、_ (MAO) _ _ _ (ADA) _ _ (LN) _ _ 2) _ _ ( _ ) _ _ _ _ _ _ _ _ _ _ _ _ _ 1.2 _ (1) _ _ _ _ _ _ _ _ _ 1) _ ( _ ) _ _ 2) _ _ _ _ _ _ 3) _ _ 4) _ _ _ ( _ ) _ _ (2) _ _ _ (3) _ 4 _ _ _ (4) _ _ _ (5) _ 2 _ _ _ (6) _ 2 _ _ _ (7) _ 37.5_ _ _ (8) _ _ _ _ _ (9) _ _ _ _ _ 6 (10) _ _ _ _ _ _ _ 2 _ _ _ 2.1 _ (1)
20、CFF _ HEPAtonorm analyzer (Accelab GmbH, D-72127 Kusterdingen, Germany) _ (2) _ _ VITROS DT60 _ ( _ )_ _ _ _ _ _ _ 1053-0189-3202_ _ _ _ _ _ _ _ _ 0208107_ (100 mmol/L) _ _ 660.7mg _ _ _ 100ml _ 4e _ _ 2.2 _ _ _ _ _ _ _ _ _ ( _ _ _ _ _ _ _ ) _ _ _ _ _ _ TIPS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
21、 _ _ _ 2.3 _ _ _ MHE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MHE _ _ _ _ _ 2.3.1 PHES _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PHES _ _ A(Number Connection Test A _ NCT-A) _ _ _ (Line Traing Test LTT) _ _ (Digit Symbol Test DST) _ (Serial Dotting Test) _ ( _ _ 2-5) _ _ _ _ 1 _ 25 _ _
22、_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4 _ 10 _ _ _ _ _ _ _ _ _ _ _ _ 5 _ _ _ _ _ 1 _ (1SD) _ 0 _ _ _ _ _ 7 _ 1 _ SD _ _ +1 _ _ _ 1_ 2 _ SD _ _ -1 _ _ 2 _ 3 _ SD _ _ -2 _ 3 _ SD _ -3 _ _ _ +4 _ -12 _ _ _ MHE _ -4 _ _ 96% _ _ _ 100% _ _ _ _ _ _ _ 2.3.2 _ _ _ _ (CFF)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 60Hz _ 1_ 1 _ _ _ _ _ _ _ _