The effect of hepatic encephalopathy, hepatic failure, and portosystemic shunt on brain volume of cirrhotic patients: a voxel-based morphometry study.
The effect of hepatic encephalopathy, hepatic failure, and portosystemic shunt on brain volume of cirrhotic patients: a voxel-based morphometry study.
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肝性脑病、肝衰竭和门体分流对肝硬化患者脑容量的影响：基于体素的形态测量研究
DOI：
10.1371/journal.pone.0042824
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Lu GM
中科院分区：
文献类型：
--
作者：
Zhang LJ;Qi R;Zhong J;Xu Q;Zheng G;Lu GM
目的应用MRI体素形态测定法（VBM）评价肝性脑病（HE）、肝功能衰竭和门系统分流（PS）对肝硬化患者脑容量改变的影响。方法选取60例肝硬化患者（显性HE [OHE]， n = 11；轻度HE [MHE]， n = 19；非HE [nHE]， n = 30），其中12例行经颈静脉肝内门体分流术（TIPS）前后扫描，对照组40例。所有患者均行神经心理学和实验室检查。对4组患者的VBM进行方差分析，对不同肝功能、PS评分、TIPS患者进行t检验。采用多元线性回归分析静脉血氨水平、Child-Pugh评分和PS对所有患者脑容量的影响。结果肝硬化患者表现为灰质（GM）多区体积减少，丘脑体积增加，白质（WM）体积增加，且HE患者脑体积受影响程度大于nHE患者。肝功能衰竭也导致GM体积减少。高PS评分和TIPS的患者在某些区域表现出GM减少和WM体积增加。tips后患者显示丘脑GM体积增加。多元协变量回归结果表明，Child-Pugh评分是影响GM体积的主要因素，而PS主要影响WM体积。结论肝硬化患者脑结构异常表现为双侧对称，且HE患者脑结构损害比非HE患者更为广泛。丘脑体积增加与HE进展无关。肝功能衰竭和PS改变了肝硬化患者的大脑结构。
PurposeTo evaluate the effect of hepatic encephalopathy (HE), hepatic failure, and portosystemic shunt (PS) on the brain volume alteration in cirrhotic patients with MRI voxel-based morphometry (VBM).MethodsSixty cirrhotic patients (overt HE [OHE], n = 11; minimal HE [MHE], n = 19; non HE [nHE], n = 30) including 12 with pre- and post-transjugular intrahepatic portosystemic shunt (TIPS) scanning and 40 healthy controls were recruited. Neuropsychological and laboratory tests were performed in all patients. VBM was analyzed with ANOVA test among 4 groups, and t-tests for patients with different hepatic function, PS scores, and TIPS. Multiple linear regression was performed to investigate the effect of venous blood ammonia levels, Child-Pugh scores, and PS on the brain volumes in all patients.ResultsCirrhotic patients exhibited decreased volume in many areas of gray matter (GM), increased volume in thalamus, and increased whiter matter (WM) volume, with the extent of affected brain volume greater in HE patients than nHE patients. Hepatic failure also resulted in decreased GM volume. Patients with high PS scores and TIPS displayed decreased GM and increased WM volume in some regions. Post-TIPS patients displayed increased GM volume in the thalamus. Multiple covariate regression results suggested that Child-Pugh score was a major factor to affect GM volume, while PS mainly affected WM volume.ConclusionBrain structure abnormalities appeared bilaterally symmetrical in cirrhotic patients, and the impairment was more extensive in HE patients than those without HE. Increased thalamus volume was not associated with HE progression. Hepatic failure and PS altered cirrhotic patients’ brain structure.
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影响因子：
4.1
作者：
DeLong, Mahlon;Wichmann, Thomas
通讯作者：
Wichmann, Thomas
DOI：
10.1073/pnas.0504136102
发表时间：
2005-07-05
影响因子：
11.1
作者：
Fox, MD;Snyder, AZ;Raichle, ME
通讯作者：
Raichle, ME
影响因子：
19.7
作者：
Brancatelli, G;Federle, MP;Geller, DA
通讯作者：
Geller, DA
影响因子：
3.7
作者：
Hsu TW;Wu CW;Cheng YF;Chen HL;Lu CH;Cho KH;Lin WC;Lin CP
通讯作者：
Lin CP
影响因子：
3.6
作者：
Gupta, Rakesh Kumar;Yadav, Santosh Kumar;Saraswat, Vivek Anand
通讯作者：
Saraswat, Vivek Anand