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是最新开发并应用于检测肝硬变患者亚临床肝性脑病的一种新的计算机系统，该系统有望用于临床，也可用于评估无神经精神症状的肝硬变患者亚临床脑病的治疗方法的有效性。2)应用正电子发射计算机断层扫描(PET)技术检测肝硬变患者脑葡萄糖代谢(CMR-Glu)的区域差异：用正电子发射计算机断层扫描(PET)技术检测有无亚临床肝性脑病(SHE)的肝硬变患者脑葡萄糖代谢(CMR-Glu)。除基底节外，非SHE组和对照组灰质的CMRglu值基本相同。CMRglu诉…非SHE组大鼠基底节区CMRGLU值明显高于对照组和SHE组。SHE组大鼠大脑灰质CMRGLU值明显低于非SHE组和对照组。3)磁共振成像(MRI)和磁共振波谱(MRS)对无明显肝性脑病(HE)的肝硬变患者的临床意义：为明确MRI上苍白球状高信号(P_1指数)和MRS脑代谢产物改变与肝功能严重程度、血氨(B-NH_3)浓度和微量元素水平的关系，对无HE的肝硬变患者行MRI和质子MRS.P_1指数、谷氨酰胺的测定，肌肌醇低于对照组，有统计学意义。肝硬化组B-NH3与肌醇呈负相关，与谷氨酸呈正相关，肌醇降低，P1指数升高，谷氨酰胺随肝功能严重程度加重而升高。无肝性肝硬变患者MR1和MRS的改变可能反映了肝功能的严重程度和氨、锰代谢的异常。4)亚临床肝性脑病的患病率和预后：在肝硬变患者中，亚临床肝性脑病的患病率估计为60%，在一年内进展为显性肝性脑病的比例约为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