-1H-MRS评估慢性肝病脑部代谢异常与肝硬化的相关性

-1H-Magnetic Resonance Spectroscopy Assess the Correlation between Cerebral Metabolic Changes and Liver Cirrhosis

目的：利用-1H-MRS研究慢性肝病脑部代谢改变,并探讨-1H-MRS评估慢性肝病脑部代谢异常与肝硬化Child-Pugh分级的相关性。方法：选取经临床确诊为慢性肝炎肝硬化患者42例（child A 19例,child B14例,child C 9例）及健康志愿者15例（对照组）,行磁共振平扫及磁共振单体素-1H-MRS检查,计算相关代谢物N-乙酰天门冬氨酸（NAA）、谷氨酰胺复合物（Glx）、胆碱（Cho）、肌醇（mI）和肌酸（Cr）的峰下面积及前四项指标与Cr的比值（NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr）,并进行统计学分析,同时对相关代谢物的变化与肝硬化Child-Pugh分级及肝硬化Child-Pugh分级与肝性脑病的关系进行相关性分析。结果：-1HMRS分析显示与正常对照组相比,慢性肝炎肝硬化组Glx/Cr值升高,Cho/Cr与mI/Cr值降低,且差异均有统计学意义（P〈0.05）;不同程度肝硬化病例组对比显示,Glx/Cr值均随着肝硬化程度加重而增大,且Glx/Cr值的差异在child A、child B、child C组中均有统计学意义（P〈0.05）;肝性脑病（HE）组与非肝性脑病组脑代谢物峰下面积比值Glx/Cr、Cho/Cr、mI/Cr比较,差异有统计学意义（P〈0.05）;Child-Pugh分级与Glx/Cr呈正相关,与Cho/Cr、mI/Cr呈负相关;随着肝硬化程度加重,肝性脑病出现概率越高,差异有统计学意义（P〈0.05）。结论：-1H-MRS作为一种无创性的评价手段,能够反映慢性肝硬化及肝性脑病患者存在脑代谢物浓度异常改变,可作为早期诊断肝硬化、肝性脑病及评价肝硬化、肝性脑病严重程度的一项指标,在一定程度上评估肝性脑病与肝硬化分级具有相关性。

Objective： To study metabolic alterations of brain in patients with chronic hepatic disease by use of -1H magnetic resonance spectroscopy（-1HMRS）, and to explore the correlation between the cerebral metabolic changes in patients with chronic liver disease evaluated by-1HMRS and the Child-Pugh classification of liver cirrhosis. Methods： Magnetic resonance plain scan and single voxel -1HMRS examinations were performed in 42 patients clinically diagnosed with chronic hepatic disease（19 cases in Child-Pugh A group, 14 cases in Child-Pugh B group and 9 cases in Child-Pugh C group） and 15 cases of healthy volunteers（control group）. The areas under peak of related cerebral metabolites（NAA, Glx, Cho, mI and Cr） and the ratio of the former four indicators with Cr（NAA/Cr,Glx/Cr, Cho/Cr, mI/Cr） have been calculated and statistically analyzed respectively. The correlation analysis of the relationship between the spectroscopic alterations of related metabolites and the Child-Pugh classification of liver cirrhosis and the relationship between the Child-Pugh classification of liver cirrhosis and hepatic encephalopathy were also conducted. Results： The -1HMRS analysis showed that when compared with the control group, the Glx/Cr ratio in patients with chronic hepatic cirrhosis were increased, while the Cho/Cr,mI/Cr ratio were reduced, and the differences were statistically significantly（P〈0.05）. The comparison within the group of different degrees of liver cirrhosis cases displayed that the Glx/Cr ratio increased with the increasing aggravation of the liver cirrhosis＇ degree, and the differences among the Glx/Cr ratio in child A, child B and child C group were statistically significantly（P〈0.05）. When comparing the ratio of areas under peak of cerebral metabolites（Glx/Cr, Cho/Cr, mI/Cr） in the hepatic encephalopathy（HE） group and non-HE group,the differences were also statistically significantly（P〈0.05）. Besides, with the degree of liver cirrhosis aggravating, the incidence rate of HE becomes higher. Conclusions： As a noninvasive evaluation method, -1HMRS can reflect the abnormal changes of cerebral metabolites concentration in patients with chronic liver cirrhosis and HE, which can be used as an indicator to help early diagnosis and assess the severity of liver cirrhosis and HE. To some extent, it will promote to evaluate the correlation with HE and the classification of liver cirrhosis.