Hepatic encephalopathy: a neurochemical, neuroanatomical, and neuropsychological study.
Hepatic encephalopathy: a neurochemical, neuroanatomical, and neuropsychological study.
复制标题
肝性脑病：神经化学、神经解剖学和神经心理学研究。
DOI：
10.1120/jacmp.v7i1.2151
复制
发表时间：
2006
影响因子：
2.1
通讯作者：
Fawzy,Fawzy
中科院分区：
文献类型：
--
作者：
Binesh,Nader;Huda,Amir;Thomas,MAlbert;Wyckoff,Nathaniel;Bugbee,Mary;Han,Steven;Rasgon,Natalie;Davanzo,Pablo;Sayre,James;Guze,Barry;Martin,Paul;Fawzy,Fawzy
肝性脑病（HE）通常通过神经心理学（NP）测试进行诊断，这些测试不是非常特异，并且不能揭示潜在的病理学。脑磁共振成像（MRI）和波谱（MRS）为HE提供了替代性和可能更特异的标记物。这些方法与NP检测结合应用，以确定它们在HE鉴定中的有用性，并更清楚地了解HE的发病机制。MR成像和光谱检查，除了电池的15 NP测试，进行调查31例等待肝移植和23名健康对照。计算苍白球区域的MR图像强度，并将其标准化为丘脑的强度。绝对浓度和比值相对于肌酸（Cr）的几种代谢产物的MR光谱计算。MR数据与NP测试结果相关。患者在注意力、视觉空间和语言流畅性的NP测试中表现出障碍。在加权MRI中，患者苍白球相对于丘脑区域的相对强度显著升高，并与三项NP测试（Hooper、FAS和Trails B）呈负相关。肌醇（mI）和胆碱（Ch）的绝对浓度在三个脑区中显著降低。此外，谷氨酰胺（Gln）和谷氨酸和谷氨酰胺（Glx）的绝对浓度增加在所有三个位置，与Gln增加是显着的在所有领域，而Glx仅在枕部白色的问题。总之，本研究部分证实了HE发病机制的假设机制，即由于血氨过多，星形胶质细胞中脑谷氨酸盐合成谷氨酰胺增加，随后肌肌醇代偿性损失以维持星形胶质细胞体积稳态。苍白球高信号可作为NP测验评分的补充，用于评价HE患者的心理健康状况。PACS编号：87.61.Pk
Hepatic encephalopathy (HE) is normally diagnosed by neuropsychological (NP) tests, which are not very specific and do not reveal the underlying pathology. Magnetic resonance imaging (MRI) and spectroscopy (MRS) of the brain offer alternative and possibly more specific markers for HE. These methods were applied in conjunction with NP testing in order to determine their usefulness in the identification of HE and to understand the pathogenesis of HE more clearly. MR imaging and spectroscopy examinations, in addition to a battery of 15 NP tests, were administered to investigate 31 patients awaiting liver transplantation and 23 healthy controls. MR image intensities from the globus pallidus region were calculated and normalized to those of the thalamus. Absolute concentrations and ratios with respect to creatine (Cr) of several metabolites were computed from MR spectra. The MR data were correlated with the results of NP tests. The patients showed impairment in NP tests of attention and visuospatial and verbal fluency. In weighted MRI, the relative intensity of the globus pallidus with respect to that of the thalamus region was significantly elevated in patients and correlated (negatively) with three NP tests (Hooper, FAS, and Trails B). The absolute concentrations of myo‐inositol (mI) and choline (Ch) were significantly reduced in three brain regions. In addition, the absolute concentrations of glutamine (Gln) and combined glutamate and glutamine (Glx) were increased in all three locations, with Gln increase being significant in all areas while that of Glx only in the occipital white matter. In summary, this study partially confirms a hypothesized mechanism of HE pathogenesis, an increased synthesis of glutamine by brain glutamate in astrocytes due to excessive blood ammonia, followed by a compensatory loss of myo‐inositol to maintain astrocyte volume homeostasis. It also indicates that the hyperintensity observed in globus pallidus could be used as complementary to the NP test scores in evaluating the mental health of HE patients.PACS number: 87.61.Pk