Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease
Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease
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DOI：
10.1053/jhep.2002.30688
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发表时间：
2002-02-01
期刊：
影响因子：
13.5
通讯作者：
Taylor-Robinson, SD
中科院分区：
文献类型：
--
作者：
Forton, DM;Thomas, HC;Taylor-Robinson, SD
慢性丙型肝炎病毒（HCV）感染的患者经常报告疲劳、倦怠、抑郁和感觉无法有效发挥功能。一些研究表明，患者表现出与疾病严重程度无关的低生活质量评分。因此，我们考虑HCV感染是否对中枢神经系统有直接影响，导致认知和大脑代谢异常。27例经活检证实为HCV所致轻度肝炎的病毒血症患者和16例HCV清除患者接受了基于计算机的认知评估电池测试，并完成了抑郁，疲劳和生活质量问卷调查。HCV感染组比HCV清除组在更多的认知任务上受损（平均值[SD]：HCV感染组，2.15 [1.56]; HCV清除组，1.06 [1.24]，P = 0.02）。因素分析显示，集中力和工作记忆速度受损，独立于静脉注射药物使用史（IVDU）、抑郁、疲劳或症状严重程度。一个亚组的17例HCV感染的患者也进行了脑质子磁共振波谱（H-1 MRS）。该组基底节和白色物质的胆碱/肌酸比值升高。与未受损患者相比，在电池中2个或更多任务受损的患者具有更高的平均胆碱/肌酸比率。总之，这些初步结果表明，在组织学轻度HCV感染的患者中，抑郁、疲劳或IVDU史无法解释认知障碍。MRS的结果表明，这种异常的生物学原因。
Patients with chronic hepatitis C virus (HCV) infection frequently report fatigue, lassitude, depression, and a perceived inability to function effectively. Several studies have shown that patients exhibit low quality-of-life scores that are independent of disease severity. We therefore considered whether HCV infection has a direct effect on the central nervous system, resulting in cognitive and cerebral metabolite abnormalities. Twenty-seven viremic patients with biopsy-proven mild hepatitis due to HCV and 16 patients with cleared HCV were tested with a computer-based cognitive assessment battery and also completed depression, fatigue and quality-of-life questionnaires. The HCV-infected patients were impaired on more cognitive tasks than the HCV-cleared group (mean [SD]: HCV-infected, 2.15 [1.56]; HCV-cleared, 1.06 [1.24], P = .02). A factor analysis showed impairments in power of concentration and speed of working memory, independent of a history of intravenous drug usage (IVDU), depression, fatigue, or symptom severity. A subgroup of 17 HCV-infected patients also underwent cerebral proton magnetic resonance spectroscopy (H-1 MRS). The choline/creatine ratio was elevated in the basal ganglia and white matter in this group. Patients who were impaired on 2 or more tasks in the battery had a higher mean choline/creatine ratio compared with the unimpaired patients. In conclusion, these preliminary results demonstrate cognitive impairment that is unaccounted for by depression, fatigue, or a history of IVDU in patients with histologically mild HCV infection. The findings on MRS suggest that a biological cause underlies this abnormality.