一项关于肝硬化病人认知障碍与跌倒关系的前瞻性研究

　　跌倒在患有衰弱性疾病的病人中会经常发生，并且严重影响到健康状况。肝硬化合并有轻微认知障碍时发生跌倒的风险可能增加。识别有风险的因素可能有助于预防措施的实施。我们的目的在于评价PHES在的预测肝硬化患者可能发生持续跌倒中的价值。应用PHES评价122例门诊肝硬化病人，并按照指定的时间间隔进行随访。根据PHES测定有三分之一的患者显示有认知障碍。在随访过程中其中有认知障碍的42个患者中，有17例(40.4%)至少发生过一次跌倒，而80个无认知障碍的只有5例(6.2%)发生跌倒。有认知障碍的患者中4例出现骨折，无认知障碍的病人未发生骨折。由于跌倒事件，合并认知障碍的患者与无认知障碍患者相比需要更多的医疗保健、急诊治疗、住院治疗。患者服用精神药物治疗可导致跌倒的发生率增加，这和PHES异常有一定相关性。在未应用精神药物的患者中(n=101),有认知障碍的发生率为32.4%，而没有认知障碍的为 7.5%。 在多元分析中，认知障碍是跌倒发生的独立预测因子。1年的跌倒发生概率有认知障碍的发生率为52.3%，而没有认知障碍的为 6.5%。异常的PHES可以辨认肝硬化患者哪些有较高的跌倒风险，这种心理测试在促进对跌倒发生的认识上有帮助，并且辨别哪些患者可以在预防对策中获益。

　　吉林大学第一医院肝胆胰内科 王中峰 摘译
本文首次发表于[HEPATOLOGY, 2012, 55:1922-1930]

Cognitive Dysfunction in Cirrhosis Is Associated With Falls: A Prospective Study

　　Falls are frequent among patients with debilitating disorders and can have a serious effect on health status.Mild cognitive disturbances associated with cirrhosis may increase the risk for falls.Identifying subjects at risk may allow the implementation of preventive measures.Our aim was to assess the predictive value of the Psychometric Hepatic Encephalopathy Score (PHES)in identifying patients likely to sustain falls.One hundred and twenty-two outpatients with cirrhosis were assessed using the PHES and were followed at specified intervals.One third of them exhibited cognitive dysfunction(CD)according to the PHES.Seventeen of the forty-two patients(40.4%)with CD had at least one fall during follow-up.In comparison,only 5 of 80(6.2%)without CD had falls(P<0.001).Fractures occurred in 4 patients(9.5%)with CD,but in no patients without CD(P<0.01). Patients with CD needed more healthcare(23.8%versus 2.5%;P<0.001),more emergency room care (14.2%versus 2.5%;P<0.02),and more hospitalization(9.5%versus 0%;P< 0.01)as a result of falls than patients without CD.Patients taking psychoactive treatment(n= 21) had a higher frequency of falls,and this was related to an abnormal PHES.In patients without psychoactive treatment(n=101),the incidence of falls was 32.4%in patients with CD versus 7.5%in those without CD(P＜0.003). In the multivariate analysis,CD was the only independent predictive factor of falls(odds ratio,10.2;95%confidence interval,3.4-30.4;P<0.001).The 1-year probability of falling was 52.3% in patients with CD and 6.5% in those without(P<0.001).Conclusion: An abnormal PHES identifies patients with cirrhosis who are at risk for falls.This psychometric test may be useful to promote awareness of falls and identify patients who may benefit from preventive strategies.

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