探讨肝硬化患者肝移植手术前后情绪状态和认知功能的变化。

本前瞻性研究对象为2012年9月至2013年9月在中山大学附属第三医院收治的26例肝硬化肝移植术前患者和24例肝硬化肝移植术后患者，另取26例健康体检者作正常对照组。所有研究对象均签署知情同意书，符合医学伦理学规定。将肝移植术前患者设为术前组，其中男23例，女3例；平均年龄（50±9）岁。将肝移植术后1个月患者设为术后组，其中男22例，女2例；年龄（50±6）岁。正常对照组男23例，女3例；年龄（49±9）岁。分别收集3组临床资料，对研究对象进行精神心理状态评定及认知功能检查，包括汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、数字连线试验A（NCT-A）、数字符号试验（DST）。多组间比较采用单因素方差分析，两两比较采用LSD-t检验。

术前组HAMD评分、HAMA评分、NCT-A测试结果、DST评分分别为（16.2±3.5）分、（17±5）分、（56±13）s、（36±11）分；术后组相应为（14.2±3.7）分、（16±3）分、（52±12）s、（42±7）分；正常对照组相应为（7.3±2.4）分、（8±3）分、（38±8）s、（54±9）分。与正常对照组相比，术前组HAMD、HAMA评分及NCT-A测试结果明显升高（LSD-t=11.919，8.596，6.883；P<0.05），DST评分明显降低（LSD-t=-6.972，P<0.05）。与正常对照组相比，术后组HAMD、HAMA评分及NCT-A测试结果明显升高（LSD-t=8.591，9.942，5.475；P<0.05），DST评分明显降低（LSD-t=-5.599，P<0.05）。与术前组相比，术后组HAMD评分明显降低（LSD-t=-2.209，P<0.05），DST评分明显升高（LSD-t=1.243，P<0.05）。

肝硬化患者肝移植术前存在明显的抑郁、焦虑及认知功能障碍，肝移植术后1个月内患者抑郁状况及认知功能明显好转，但尚未恢复至正常水平，焦虑状况改善不明显。

To investigate the change of mood and cognitive function of patients with liver cirrhosis before and after liver transplantation (LT).

A total of 26 patients with liver cirrhosis before LT and 24 patients after LT admitted in the Third Affiliated Hospital of Sun Yat-sen University from September 2012 to September 2013 were included in this prospective study. Moreover, 26 healthy controls were also included in normal control group. The informed consents of all participants were obtained and the local ethical committee approval had been received. The 26 patients before LT were assigned in preoperative group, among them, 23 were males and 3 were females with the average age of (50±9) years old. The 24 patients after LT were assigned in postoperative group, among them, 22 were males and 2 were females with the average age of (50±6) years old. Among the healthy controls, 23 were males and 3 were females with the average age of (49±9) years old. Clinical data of the three groups were collected respectively. The mood status and the cognitive function of the participants were assessed with Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), Number Connection Test A (NCT-A) , Digit Symbol Test (DST). The results of multiple groups were compared with one-way analysis of variance and pairwise comparisons were conducted with LSD-t test.

The HAMD, HAMA scores, NCT-A results and DST scores of the preoperative group were (16.2±3.5), (17±5), (56±13) s and (36±11) and those of the postoperative group were (14.2±3.7), (16±3), (52±12) s and (42±7) and those of the normal control group were (7.3±2.4), (8±3), (38±8) s and (54±9). Compared with the normal control group, the HAMD, HAMA scores and NCT-A results of the preoperative group increased significantly (LSD-t=11.919, 8.596, 6.883; P<0.05) and the DST scores decreased significantly (LSD-t=-6.972, P<0.05). Compared with the normal control group, the HAMD, HAMA scores and NCT-A results of the postoperative group increased significantly (LSD-t=8.591, 9.942, 5.475; P<0.05) and the DST scores decreased significantly (LSD-t=-5.599, P<0.05). Compared with preoperative group, the HAMD scores of the postoperative group decreased significantly (LSD-t=-2.209, P<0.05) and the DST scores increased significantly (LSD-t=1.243, P<0.05).

Patients with liver cirrhosis have obvious depression, anxiety and cognitive disorder before LT. A month after LT, depression and cognitive disorder improve obviously, but cannot recover to the normal level. The anxiety improvement is not obvious.