Modulation of neural activation following treatment of hepatic encephalopathy
Modulation of neural activation following treatment of hepatic encephalopathy
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DOI：
10.1212/wnl.0b013e31828726e1
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发表时间：
2013-03-01
期刊：
影响因子：
9.9
通讯作者：
Taylor-Robinson, Simon D.
中科院分区：
文献类型：
--
作者：
McPhail, Mark J. W.;Leech, Robert;Taylor-Robinson, Simon D.
目的：检测轻型肝性脑病患者治疗过程中的精神状态、神经活动、脑容量和脑代谢产物浓度的变化。方法：对22例经病理证实的不同病因的代偿性肝硬变患者给予门冬氨酸L鸟氨酸口服治疗，疗程4周。进行基线和4周的临床回顾、血液化学和心理测量评估(心理测量肝性脑病评分和认知药物研究评分)。使用高度简化的视觉运动任务，结合基底神经节的质子磁共振波谱，进行了全脑体积和功能磁共振成像。结果：虽然临床、生化状态、基底节磁共振波谱及局部BV无明显改变，但认知药物研究评分(+1.2，p=0.003)和心理测量肝性脑病评分(+1.5，p=0.003)均有明显改善。伴随着这种认知改善的是，扣带回后部和前额叶腹侧皮质的血氧水平依赖的激活发生了变化，这两个区域构成了大脑结构和代谢核心的一部分。此外，还有更大的视觉皮质激活的证据。结论：这些结构上相互联系的区域在脑病治疗成功后都显示出功能的增强。由于没有观察到BV的区域性变化，这表明与星形胶质细胞体积调节无关的机制参与了认知能力的显著改善。神经病学(R)2013；80：1041-1047
Objective: To measure changes in psychometric state, neural activation, brain volume (BV), and cerebral metabolite concentrations during treatment of minimal hepatic encephalopathy.Methods: As proof of principle, 22 patients with well-compensated, biopsy-proven cirrhosis of differing etiology and previous minimal hepatic encephalopathy were treated with oral L-ornithine L-aspartate for 4 weeks. Baseline and 4-week clinical review, blood chemistry, and psychometric evaluation (Psychometric Hepatic Encephalopathy Score and Cognitive Drug Research Score) were performed. Whole-brain volumetric and functional MRI was conducted using a highly simplistic visuomotor task, together with proton magnetic resonance spectroscopy of the basal ganglia. Treatment-related changes in regional BV and neural activation change (blood oxygenation level dependent) were assessed.Results: Although there was no change in clinical, biochemical state, basal ganglia magnetic resonance spectroscopy, or in regional BV, there were significant improvements in Cognitive Drug Research Score (+1.2, p = 0.003) and Psychometric Hepatic Encephalopathy Score (+1.5, p = 0.003) with treatment. This cognitive amelioration was accompanied by changes in blood oxygenation level-dependent activation in the posterior cingulate and ventral medial prefrontal cortex, 2 regions that form part of the brain's structural and metabolic core. In addition, there was evidence of greater visual cortex activation.Conclusions: These structurally interconnected regions all showed increased function after successful encephalopathy treatment. Because no regional change in BV was observed, this implies that mechanisms unrelated to astrocyte volume regulation were involved in the significant improvement in cognitive performance. Neurology (R) 2013; 80: 1041-1047