Sirozlu hastalarda subklinik hepatik ensefalopati sikligi ve klinik önemi
The frequency of and clinical importance subclinical hepatic encephalopathy in cirrhotic patients
Çukurova Üniversitesi Tip Fakültesi, Nöroloji Anabilim Dali2, Gastroenteroloji Bilim Dali3 Adana
Özet
Giris ve amaç: Bu çalismada sirozlu hastalarda subklinik hepatik ensefalopati sikligi arastirildi. Gereç ve yöntem: Çalisma 75 sirozlu olgu ile bu olgularla benzer yas, cinsiyet ve egitim düzeyinde olan saglikli 75 olguda yapildi. Subklinik hepatik ensefalopati sikligini saptamak için psikometrik testlerden Number Connection Test ile elekrofizyolojik testlerden somatosensoriel uyarilmis potansiyel, görsel uyarilmis potansiyel ve beyinsapi uyarilmis potansiyel testleri uygulandi. Ayrica bu hastalara görüntüleme yöntemlerden elektroensefalografi ve “magnetic rezonans imaging” incelemeleri yapildi. Bulgular: Psikometrik testlerden Number Connection Test %22, elektrofizyolojik testlerden somatosensoriel uyarilmis potansiyel % 44, beyinsapi uyarilmis potansiyel % 2.7 ve görsel uyarilmis potansiyel % 2.7 olguda anormal bulgu verdi. Görüntüleme yöntemlerinden elektroensefalografi % 5.3 ve magnetic rezonans imaging % 32 olguda anormal bulundu. Bu sonuçlar asikar ensefalopati olmaksizin sirozlu hastalarin bir kisminda subklinik hepatik ensefalopatinin mevcut oldugunu ve bu olgularin kolaylikla karaciger komasina girebileceklerini düsündürmektedir. Sonuç: Kanimizca özellikle motorlu araç kullanimi, makina isletme gibi agir sorumluluk gerektiren islerde çalisan sirozlu hastalarda subklinik hepatik ensefalopatinin arastirilmasi, tedavi edilmesi ve bu olgularin daha yakindan izlenmesi gerekmektedir.
Abstract
Background and aim: In this study, the frequency of subclinical hepatic encephalopathy in cirrhotic patients was investigated. Methods: Seventy five cirrhotic patients and 75 healthy controls of the same age, sex and education level were included. In order to diagnose subclinical hepatic encephalopathy, the number connection test-A as a psychometric test, and somatosensory evoked potential, visual evoked potential and Brain-stem auditory-evoked potential as electrophsiological tests were used. Electroencephalography and magnetic resonance imaging procedures were performed on each patient. Results: Abnormal results for number connection test-A, somatosensory evoked potential, brainstem auditory-evoked potantial and visual evoked potential were 23%, 44%, 2.7% and 2.7% respectively. The frequency of abnormality as diagnosed by electroencepholography and magnetic resonance imaging were 5.3% and 32% respectively. The results indicated that subclinical hepatic encephalopathy was potentially present in some cirrhotic patients and that some of them might progress to overt hepatic coma. Conclusions: Periodic follow-up of these patients is necessary due to the negative effects that subclinical hepatic encephalopathy may have on physical tasks such as driving and manual work.
