Does liver-disease aetiology have a role in cerebral blood-flow alterations in liver cirrhosis?
Does liver-disease aetiology have a role in cerebral blood-flow alterations in liver cirrhosis?
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DOI：
10.1097/00042737-200409000-00012
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发表时间：
2004-09-01
影响因子：
2.1
通讯作者：
Dam, M
中科院分区：
文献类型：
--
作者：
Burra, P;Senzolo, M;Dam, M
使用脑成像技术的研究显示肝硬化患者的局部血流量（rCBF）发生了变化。目前尚不清楚肝病的病因是否能解释这些变化。目的探讨肝硬化的病因是否与不同类型的rCBF有关。材料与方法对50例无明显脑病的终末期肝病患者进行研究。13名年龄匹配的受试者因头痛入院神经内科作为对照。排除标准为局灶性脑病变、严重脑萎缩、计算机断层扫描发现提示其他中枢神经系统疾病的异常、饮酒或使用神经活性药物至少6个月。采用单正电子发射断层扫描（SPECT），以tc -99m-六甲基丙烯胺肟（Tc-99m-HM-PAO）作为示踪剂，对所有患者和对照组的rCBF进行评估。采用Mann-Whitney U检验进行统计分析。结果19例肝病病因为酒精(A)型；病毒(V)（乙型肝炎病毒、丁型肝炎病毒、丙型肝炎病毒）14例；酒精伴病毒（A+V） 5例；胆汁淤积(C)（原发性胆汁性肝硬化，原发性硬化性胆管炎）12例。SPECT显示肝硬化患者在大多数皮质和皮质下区域的rCBF显著低于对照组，酒精和病毒患者在某些皮质区域的rCBF显著低于胆汁淤积性肝病患者。当患者根据先前的酒精滥用（包括伴随病毒病因的病例）分组时，酒精组的额上、内侧和颞下区域的rCBF明显较低。结论肝硬化患者的脑血流量明显低于对照组，在肝硬化患者中，酒精性和病毒性肝硬化患者的脑血流量低于胆汁淤积性肝病患者。在有酒精滥用史的患者中，与没有酒精滥用史的患者相比，额叶区和颞叶区的脑血流量明显减少。
Background Studies using brain-imaging techniques have shown changes in regional blood flow (rCBF) in patients with liver cirrhosis. It remains unknown whether the aetiology of liver disease accounts for these changes.Aims To evaluate whether the aetiology of liver cirrhosis is associated with different patterns of rCBF.Materials and methods A total of 50 patients with end-stage liver disease and no overt encephalopathy were studied. Thirteen age-matched subjects admitted to the neurology department for headache were used as controls. Exclusion criteria were focal brain lesions, severe brain atrophy and any abnormalities found on computed tomography scan suggesting other central nervous system diseases, alcohol intake or use of neuroactive drugs for at least 6 months. rCBF was assessed using single-positron-emission tomography (SPECT) with Tc-99m-hexamethylpropylene amine oxime (Tc-99m-HM-PAO) as a tracer in all patients and controls. The Mann-Whitney U test was used for statistical analysis.Results The liver-disease aetiology was as follows: alcoholic (A) in 19 patients; viral (V) (hepatitis B virus, hepatitis D virus, hepatitis C virus) in 14 patients; alcoholic with concomitant viral (A+V) in five patients; and cholestatic (C) (primary biliary cirrhosis, primary sclerosing cholangitis) in 12 patients. SPECT showed significantly lower rCBF in cirrhotic patients than in controls for most cortical and subcortical regions and in alcoholic and viral patients than in cholestatic liver disease patients for some cortical regions. When patients were grouped according to previous alcohol abuse (including cases with a concomitant viral aetiology), rCBF was significantly lower in the frontal superior, medial and temporal inferior regions in the alcoholic group.Conclusions Cerebral blood flow is significantly lower in patients with liver cirrhosis than in controls and, among cirrhotics, it is lower in alcoholic and viral cirrhosis than in cholestatic liver disease. In patients with previous alcohol abuse, cerebral blood flow was significantly more reduced in the frontal and temporal regions compared with patients without previous alcohol abuse.