肝硬化患者脑灰质结构的纵向MRI改变

Longitudinal MRI changes of brain gray matter in hepatic cirrhosis patients

目的探讨应用MRI评价肝硬化(HC)患者全脑灰质结构随时间变化的特征。方法对15例单纯HC患者肝脏储备功能进行量化评估,并进行神经心理学测试及大脑结构MR扫描,间隔2年随访,采用SPM8基于体素的形态学方法进行结构数据处理。结果纵向对比发现,维持有效治疗2年后,HC患者肝功能评分得以有效控制,但大脑双侧直回/眶回灰质体积明显缩小,而双侧中央前回灰质体积显著增大,且Child-Pugh评分和神经心理学测试评分减低。结论随病程持续进展,HC患者大脑灰质体积的改变逐渐明显,其结构的改变可能是导致轻微肝性脑病发生发展的结构基础。

Objective To explore the characteristics of structural abnormalities in the time-varying longitudinal course of hepatic cirrhosis （HC） patients with MRI. Methods Fifteen HC patients were enrolled to perform neuropsychological tests, quantitative assessment of hepatic function and structural MR scanning at baseline and again 2 years later. Gray mat- ter changes over time were measured with voxel-based morphometry using SPM8. Results At the 2-year follow-up, it im- proved obviously in Child-Push scores, and decreased from baseline in neuropsychological tests of HC patients with mainte- nance therapy, and the alterations of gray matter volumes decreased in bilateral rectal gyrus/orbital gyrus, whereas in- creased significantly in bilateral precentral gyrus. Conclusion There are significant changes of gray matter volumes in spe- cific regions of HC patients with disease progression, which may be associated with cognitive and neuropsychiatric impair- ment of minimal hepatic encephalopathy patients.