Reassessment of the pathogenesis and the management of hepatic encephalopathy : include the cases of subclinical hepatic encephalopathy

1)计算机辅助定量神经心理学测验的开发：计算机辅助定量神经心理学测验是一种新的计算机辅助定量神经心理学测验，可用于肝硬化患者亚临床肝性脑病的检测，并可用于无神经精神症状的肝硬化患者亚临床脑病治疗策略的疗效评价。2)应用正电子发射断层显像（PET）研究肝硬化患者脑葡萄糖代谢（CMRglu）的区域性差异：应用PET检测肝硬化患者伴或不伴亚临床肝性脑病（SHE）的CMRglu，SHE灰质CMRglu值低于对照组（P<0.05），尤以额颞区和基底节区为甚（P<0.05）。非SHE组和对照组灰质CMRglu值除基底节外基本相同。CMRglu v ...更多信息 非SHE组基底神经节CMRglu值高于对照组和SHE组，SHE组灰质CMRglu值随玉米对非SHE组和对照组的处理而降低。3)磁共振成像（MRI）和磁共振波谱（MRS）对无明显肝性脑病（HE）的脑卒中患者的临床意义：阐明苍白球高信号的变化（P1指数）和MRS脑代谢产物与肝功能严重程度、血氨（B-NH 3）浓度和微量元素含量的关系，肝硬化组P1指数、谷氨酰胺水平高于对照组，肌醇水平低于对照组，差异有统计学意义。肝硬化患者B-NH3与肌醇呈负相关，与谷氨酰胺呈正相关，且随着肝功能损害程度的加重，肌醇降低，P1指数、谷氨酰胺升高。在无HE的肝硬化患者中，MR 1和MRS的改变已被检测到，这些改变可能反映了氨和锰的代谢以及肝功能的严重程度。4)亚临床肝性脑病（SHE）的患病率和预后：肝硬化患者中SHE的患病率估计为60%，肝硬化SHE患者在一年内进展为明显肝性脑病的百分比约为40%。

1) Development of computer-assisted quantitative neuroosychological tests : Computer-assisted quantitative neuropsychological tests were newly developed and applied for detection of subclinical hepatic encephalopathy in patients with liver cirrhosis.A new computer system is expected to be clinically useful and also for evaluating the effectiveness of therapeutic maneuvers of subclinical encephalopathy in cirrhotic patients without neuropsychiatiric symptoms. 2) Regional differences of cerebral lucose metabolism (CMR glu) in patients with liver cirrhosis using positron emission tomographv (PET) : The CMRglu in cirrhotic patients with or without subclinical hepatic encephalopathy (SHE) were measured using PET.CMRgIu value in the gray matter of SHE is lower than (hat of control, particularly in the frontal and temporal regions and basal ganglia (p<O.O5, respectively). The CMRglu values in the gray matter of non-SHE and control are almost the same, excepting the basal ganglia. The CMRglu v … More alue in the basal ganglia of non-SHE is higher than that of control and SHE.The CMRglu value in the gray matter of SHE is depressed as corn pared to both non-SHE and control. 3) Clinical relevance of magnetic resonance imagin g( MRI) and magnetic resonance spectroscopy (MRS) for the cirrhotic without overt hepatic encephaIopathv (HE) : To clarify the changes of pallidal high intensity (P1 index) on TI-weighted MRI and brain metabolites on MRS as related to the severity of hepatic functions, the concentrations of blood ammonia (B-NH3) and the tevels of trace elements, patients with liver cirrhosis without HE underwent MRI and proton MRS.P1 index and glutamine are higher in cirrhosis, and myo-inositol is lower than that of control statistically. In cirrhosis, there were statistically negative correlation between B-NH3 and myo-inositol and positive correlation between B-NH3 and glutamine.There was a statistically lower myoinositol and higher P1 index, glutamine as the severity of hepatic functions increased. Furthermore there was a statistically positive correlation between P1 index and Mn.The changes of MR1 and MRS findings already detected in cirrhosis without HE and these abnormalities may be reflect the ammonia and Mn metabolism andthe severity of the hepatic functions. 4) The prevalence and prognosis of subclinical hepatic encephalopathv (SHE) : The prevalence of SHE among patients with liver cirrhosis was estimated 60% and The percentage of the progression to the overt hepatic -encephalopathy is apprbximately 40% of liver cirrhosis with SHE within a yeair Less