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测试的发展：计算机辅助定量神经心理测试被新开发并应用于肝硬化患者亚临床肝性脑病的检测。一种新的计算机系统有望在临床上有用，也可用于评估无神经精神症状的肝硬化患者的亚临床脑病治疗策略的有效性。2)使用正电子发射断层扫描（PET）检测肝硬化患者脑葡萄糖代谢（CMR glu）的区域差异：使用PET检测合并或不合并亚临床肝性脑病（SHE）的肝硬化患者的CMRglu。脑梗死脑灰质CMRgIu值明显低于对照组，尤其是额叶区、颞叶区和基底节区（p< 0.05）。O5,分别)。除基底节区外，非she组灰质CMRglu值与对照组几乎相同。CMRglu v . More值在基底节区非SHE组高于对照组和SHE组。与非SHE组和对照组相比，SHE组灰质中的CMRglu值降低。3)磁共振成像（MRI）和磁共振波谱（MRS）对肝硬化无明显肝性脑病（HE）的临床意义：为了阐明ti加权MRI上pallidal高强度（P1指数）和MRS上脑代谢物与肝功能严重程度、血氨（B-NH3）浓度和微量元素水平的关系，肝硬化无HE患者行MRI检查，肝硬化患者质子MRS.P1指数和谷氨酰胺均高于对照组，肌醇低于对照组。肝硬化患者B-NH3与肌醇呈负相关，与谷氨酰胺呈正相关。随着肝功能严重程度的增加，肌醇降低，P1指数、谷氨酰胺升高。P1指数与Mn呈显著正相关。无HE肝硬化患者MR1和MRS的变化可能反映了氨锰代谢和肝功能的严重程度。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%，一年内进展为显性肝性脑病的比例约为肝硬化合并SHE的40%以下

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