Minimal hepatic encephalopathy in children: evaluation with proton MR spectroscopy.
Minimal hepatic encephalopathy in children: evaluation with proton MR spectroscopy.
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DOI：
10.3174/ajnr.a1652
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Schwarz KB
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文献类型：
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作者：
Foerster BR;Conklin LS;Petrou M;Barker PB;Schwarz KB
由于缺乏针对所有年龄段的标准化神经心理学测试，因此很难评估儿童的轻微肝性脑病（MHE）。这项针对临床怀疑患有 MHE 的儿童的回顾性研究的目的是调查脑磁共振波谱 (MRS) 代谢物与脑病生化标志物以及肝病严重程度测量之间的关系。通过 1.5 特斯拉磁铁上的短回波时间脑部 MRS 对 12 名临床怀疑患有 MHE 的儿童（9-19 岁，8 名女性）进行了研究。使用“LCModel”软件估计灰质和白质代谢浓度。检查区域代谢物浓度与各种参数的相关性，包括血浆氨、支链与芳香氨基酸的比率 (BCAA/AAA)、MELD/PELD 和 Child Pugh 评分、胆红素、白蛋白和血小板计数。 mI 水平与 BCAA/AAA 比率相关（GM 和 WM 分别为 r=0.86，p=0.002，r=0.77，p=0.01）。 WM Cho 水平和 GM mI 水平与氨水平呈显着负相关（分别为 r=-0.58，p=0.04 和 r=-0.65，p=0.02）。 GM Glx 与氨水平存在显着正相关趋势（r=0.66，p=0.05）。脑部 MRS 参数与肝脏疾病严重程度没有相关性。疑似 MHE 儿童的脑 MRS 代谢物与血浆氨和 BCAA/AAA 显着相关。与成人一样，儿童脑部 MRS 可能有助于 MHE 的诊断。
Minimal hepatic encephalopathy (MHE) in children is difficult to evaluate due to lack of standardized neuropsychological tests over all age ranges. The purpose of this retrospective study of children with clinically suspected MHE was to investigate relationships between brain magnetic resonance spectroscopy (MRS) metabolites and biochemical markers of encephalopathy as well as liver disease severity measures. 12 children (ages 9–19, 8 female) with clinically suspected MHE were studied by short echo time brain MRS on a 1.5 Tesla magnet. Gray and white matter metabolite concentrations were estimated using ‘LCModel’ software. Regional metabolite concentrations were examined for correlation with various parameters, including plasma ammonia, the ratio of branched chain to aromatic amino acids (BCAA/AAA), MELD/PELD and Child Pugh scores, bilirubin, albumin, and platelet counts. mI levels correlated with BCAA/AAA ratios (r=0.86,p=0.002, r=0.77,p=0.01 for GM and WM respectively). WM Cho levels and GM mI levels showed significant negative correlation with ammonia levels (r=−0.58,p=0.04 and r=−0.65,p=0.02 respectively). Positive significant correlation trend was present for GM Glx and ammonia levels (r=0.66,p=0.05). There was no correlation of brain MRS parameters and liver disease severity. Brain MRS metabolites in children with suspected MHE show significant correlations with plasma ammonia and BCAA/AAA. As in adults, brain MRS in children may be helpful in establishing a diagnosis of MHE.