Serial Evaluation of Children With ALF With Advanced MRI, Serum Proinflammatory Cytokines, Thiamine, and Cognition Assessment
Serial Evaluation of Children With ALF With Advanced MRI, Serum Proinflammatory Cytokines, Thiamine, and Cognition Assessment
复制标题
DOI：
10.1097/mpg.0b013e31825f4c3e
复制
发表时间：
2012-11-01
影响因子：
2.9
通讯作者：
Gupta, Rakesh K.
中科院分区：
文献类型：
--
作者：
Srivastava, Anshu;Yadav, Santosh K.;Gupta, Rakesh K.
目的：这项前瞻性、序贯性研究旨在了解急性肝功能衰竭（ALF）儿童的磁共振成像和磁共振波谱、肝功能和神经认知测试（NCT）的脑水肿（CE）变化。对11例ALF和8例健康对照者进行了高级磁共振（MR）成像、血液促炎细胞因子（PC）、硫胺素水平、肝功能、和NCT。在43.5 +/- 26.9天时进行重新评价（首次随访，n = 8）和157.3 +/- 52.3天（第二次随访，n = 6）出院后。诊断时，ALF患者具有血管源性和细胞毒性CE，脑谷氨酰胺升高，（23.2 +/- 3.4 vs 15.3 +/- 2.7）和血清PC（肿瘤坏死因子[TNF]-α 40.1 +/- 8.9 vs 7.2 +/- 2.7 pg/mL，白细胞介素[IL]-6 29.2 +/- 14.4 vs 4.7 +/- 1.2 pg/mL）。乳头体（MB）较小，脑胆碱（1.9 +/- 0.36 vs 2.6 +/- 0.6）和血硫胺素（55.2 +/- 6.7 vs 81.8 +/- 10.2 nmol/L）低于对照组。首次随访时，脑谷氨酰胺和CE恢复。脑胆碱和MB体积显示改善，硫胺素水平正常化。观察到TNF-α和IL-6显著降低。患者在NCT上表现不佳，在第二次随访时恢复正常。肝生化和硫胺素水平正常，TNF-α和IL-6显示进一步减少在第二次follow-up.Conclusions：ALF患者有CE由脑谷氨酰胺和PC升高。由于硫胺素缺乏，MB较小，并在随访中显示恢复。CE和脑谷氨酰胺恢复早于NCT和肝功能正常化。持续升高的细胞因子在损伤后长达6个月，表明可能来自肝再生。
Objectives: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF).Methods: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 +/- 26.9 days (first follow-up, n = 8) and 157.3 +/- 52.3 days (second follow-up, n = 6) after discharge.Results: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 +/- 3.4 vs 15.3 +/- 2.7), and serum PCs (tumor necrosis factor [TNF]-alpha 40.1 +/- 8.9 vs 7.2 +/- 2.7 pg/mL, interleukin [IL]-6 29.2 +/- 14.4 vs 4.7 +/- 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 +/- 0.36 vs 2.6 +/- 0.6) and blood thiamine (55.2 +/- 6.7 vs 81.8 +/- 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-alpha and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-alpha and IL-6 showed further reduction at second follow-up.Conclusions: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.