Effects of anti-viral therapy and HCV clearance on cerebral metabolism and cognition
Effects of anti-viral therapy and HCV clearance on cerebral metabolism and cognition
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DOI：
10.1016/j.jhep.2011.09.015
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发表时间：
2012-03-01
影响因子：
25.7
通讯作者：
Afdhal, Nezam H.
中科院分区：
文献类型：
--
作者：
Byrnes, Valerie;Miller, Anne;Afdhal, Nezam H.
背景与目的：慢性丙型肝炎病毒（HCV）感染与脑代谢改变和认知功能障碍有关。我们的目的是评估聚乙二醇化干扰素/利巴韦林 (PIFN/R) 和 HCV 清除对脑代谢和神经心理学表现的影响。方法：15 名非肝硬化 HCV 阳性受试者在 PIFN/R 治疗前、治疗期间和治疗后接受 H-1 磁共振波谱 (MRS) 检查。感兴趣的代谢物，即 N-乙酰天冬氨酸 (NAA)、胆碱 (Cho)、肌醇 (MI) 和对照代谢物肌酸 (Cr)，是从 3 个不同的大脑区域获得的；左基底神经节、左额叶皮质和左背外侧前额叶皮质。与此同时，受试者还接受了一系列神经心理学测试，以评估言语学习、记忆、注意力、语言、执行功能和运动技能等领域。七名 HCV 阳性对照（未接受抗病毒治疗）在两个时间点（相隔 12 周）接受了 MRS 和神经心理学测试，以检查脑代谢物随时间的变化以及重复神经心理学测试的实践效果。 结果：在持续病毒学应答者（SVR、 n = 8），但不是无反应者/复发者（NR/R，n = 6），表明清除病毒的人脑部感染和/或免疫激活减少。 SVR 在言语学习、记忆和视觉空间记忆方面表现出显着改善。在治疗期间，HCV 对照和 HCV 受试者均观察到继练习效果后，神经认知功能出现小幅但显着的改善。结论：HCV 根除对脑代谢和神经认知功能的选择性方面具有有益作用，是考虑 HCV 抗病毒治疗时的一个重要因素，尤其是对于病情较轻的患者。 (C) 2011 年欧洲肝脏研究协会。由 Elsevier B.V. 出版。保留所有权利。
Background & Aims: Chronic hepatitis C virus (HCV) infection is associated with altered cerebral metabolism and cognitive dysfunction. We aimed to evaluate the effect of pegylated interferon/ribavirin (PIFN/R) and HCV clearance on cerebral metabolism, and neuropsychological performance.Methods: Fifteen non-cirrhotic HCV positive subjects underwent H-1 MR spectroscopy (MRS) before, during, and after treatment with PIFN/R. The metabolites of interest namely, N-acetylaspartate (NAA), choline (Cho), myo-inositol (MI), and the control metabolite creatine (Cr), were acquired from 3 different brain regions; left basal ganglia, left frontal cortex, and left dorso-lateral pre-frontal cortex. Coinciding with this, subjects also underwent a battery of neuropsychological tests to evaluate the domains of verbal learning, memory, attention, language, executive functioning, and motor skills. Seven HCV positive controls (not receiving anti-viral therapy) underwent MRS and neuropsychological testing at two time points, 12 weeks apart, to examine for variation in cerebral metabolites over time and the practice effect of repeat neuropsychological testing.Results: Significant reductions in basal ganglia Cho/Cr (p = 0.03) and basal ganglia MI/Cr (p = 0.03) were observed in sustained virological responders (SVRs, n = 8), but not non-responders/relapsers (NR/R, n = 6), indicative of reduced cerebral infection and/or immune activation in those who cleared virus. SVRs demonstrated significant improvements in verbal learning, memory, and visuo-spatial memory. A small but significant improvement in neurocognitive function secondary to the practice effect was seen in both HCV controls and HCV subjects during treatment.Conclusions: HCV eradication has a beneficial effect on cerebral metabolism and selective aspects of neurocognitive function and is an important factor when contemplating anti-viral therapy in HCV, especially in those with mild disease. (C) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.