肝硬化患者经颈静脉肝内门体分流术后脑功能变化静息态功能磁共振观察

Resting-state functional magnetic resonance study of brain function changes after TIPS operation in patients with liver drrhosis

目的 通过静息态功能磁共振成像（fMRI）检测并进行比率低频振幅分析，研究肝硬化患者经颈静脉肝内门体分流（TIPS）术后脑功能变化特点。方法 选取2014年1月至2016年2月于安徽医科大学第一附属医院介入科及感染科就诊的TIPS术后患者，收集TIPS术后1、3、6、12个月四组共96例肝硬化患者血氨数据，均行静息态fMRI扫描。采用静息态fMRI数据处理助手DPARSF及统计参数图软件包SPM12软件进行静息态功能数据处理，计算全脑比率低频振幅值，并进行单因素方差分析和多重比较分析及相关性分析。结果 TIPS术后1、3、6和12个月四组患者脑功能差异有统计学意义的脑区包括，双侧颞上回、右侧颞中回、右侧海马（x＝24，y＝–9，z＝–21）、右侧岛盖部额下回、左侧梭状回（x＝–42，y＝–36，z＝–24）、左侧嗅皮质及左侧额上回眶部（x＝–21，y＝36，z＝–18）（均P〈0.005）。多重比较显示，与术后1个月比较，术后3个月功能增强脑区包括：左侧嗅皮质、左侧颞下回、左侧梭状回、左侧眶部额中回、左侧豆状壳核、左侧小脑，减低脑区为左侧舌回；术后6个月功能增强脑区包括：左侧颞中回、右侧缘上回、右侧颞极、右侧中央沟盖，减低脑区包括：左侧顶下缘角回、左侧中央后回；术后12个月功能增强脑区包括：右侧海马、右中扣带回；减低脑区为右颞中回。与术后3个月相比较，术后6个月功能增强脑区包括：左侧颞上回、左侧颞中回、右侧颞极、右岛盖部额下回，减低脑区包括：左侧小脑、左侧眶部额上回；术后12个月患者无明显功能增强及减低的脑区。与术后6个月相比较，术后12个月无明显功能增强脑区，减低脑区为双侧颞中回（P〈0.001）。与血氨水平正相关脑区包括：中扣带回，右中央沟盖，左侧海马旁回；负相关脑区包括：双侧前额叶内侧、前扣带和旁扣带回、右侧顶下缘角回、右侧颞中回、左侧中央前回及中央后回（均P〈0.005）。结论 肝硬化患者TIPS术后静息态脑功能随病程变化而增强或减弱，边缘系统及感觉运动系统脑区活动均与血氨水平有显著相关性，术后6个月血氨水平及相关脑区功能可逐渐改善。

Objective To investigate the brain function changes in cirrhosis patients after transjugular intrahepatic portosystemic shunt （TIPS）, resting-state functional MRI （rs-fMRI） performed and fractional amplitude of low frequency fluctuation （fALFF） was analyzed.Methods From January 2014 to February 2016, a total of 96 cirrhotic patients from invasive technology department and infection department in the First Affiliated Hospital of Anhui Medical University were selected , the blood ammonia data of 96 cirrhotic patients with TIPS operation in four groups were collected after 1, 3, 6 and 12 month, and all subjects performed rs-fMRI scans. The rs-fMRI data processed with DPARSF and SPM12 softwares, whole-brain fALFF values were calculated, and One-Way analysis of variance , multiple comparison analysis and correlation analysis were performed.Results There were brain regions with significant function changes in four groups patients with TIPS operation after 1, 3, 6 and 12 month, including bilateral superior temporal gyrus, right middle temportal gyrus , right hippocampus, right island of inferior frontal gyrus, left fusiform gyrus, left olfactory cortex, left orbital superior frontal gyrus （all P〈0.005）. Multiple comparison analysis showed that compared with patients in the 1-month follow-up, patients in the 3-month follow-up showed that brain function areas increased in left olfactory cortex, left inferior temporal gyrus, left fusiform gyrus, left orbital middle frontal gyrus, left putamen, left cerebelum, and decreased in left lingual gyrus; patients in the 6-month follow-up showed that brain function areas increased in left middle temportal gyrus, right supramarginal gyrus, right temporal pole, right central operculum, and decreased in left top edge of angular gyrus, left postcentral gyrus; patients in the 12-month follow-up showed that brain function areas increased in right hippocampus, right middle cingulate gyrus, and decreased in right middle temportal gyrus.Compared with patients in the 3-month follow-up, patients in the 6-month follow-up showed that brain function areas increased in left superior temporal gyrus, left middle temporal gyrus, right temporal pole, right island of inferior frontal gyrus, and decreased in left cerebelum, left orbital inferior frontal gyrus; patients in the 12-month follow-up showed that there were no obvious increase and decrease brain function areas.Compared with patients in the 6-month follow-up, patients in the 12-month follow-up showed that there were no obvious increase brain function areas , but brain function areas decreased in bilateral middle temportal gyrus（P〈0.001）. Brain regions were positively related to blood ammonia in right middle cingulate gyrus, right central operculum, left parahippocampal gyrus, while as brain regions were negatively related to blood ammonia in bilateral medial prefrontal lobe, anterior cingulate and paracingulate gyrus, right top edge of angular gyrus, right middle temportal gyrus, left anterior central gyrus, left posterior central gyrus （all P〈0.005）.Conclusion The resting state brain function increased or decreased with course of disease in cirrhosis patients after TIPS operation. The brain activity of limbic system and sensorimotor system all had significant correlation with blood ammonia levels. The blood ammonia level and the function of relative brain regions after 6-month with TIPS operation can be gradually improved.