高胆红素血症肝硬化患者静息态功能MRI脑功能变化

Brain function changes of resting-state functional MRI in cirrhotic patients with hyperbilirubinemia

目的采用静息态功能MRI局部一致性(ReHo)的方法,探讨血氨正常高间接胆红素肝硬化患者脑功能的改变。方法分别对53例血氨正常高间接胆红素肝硬化患者(肝硬化组)及60名健康志愿者(正常对照组)行静息态fMRI,采用ReHo方法分析,比较并获得2组ReHo值的差异性脑区。将2组差异性脑区的ReHo值与间接胆红素浓度进行相关分析。结果与正常对照组相比较,肝硬化组ReHo值增高的脑区包括左背外侧额上回、左眶部额上回、左顶下缘角回、左中央前回、右尾状核、右豆状壳核、右岛叶、右嗅皮质(P均<0.001),ReHo值降低的脑区包括左枕上回、左枕中回、左楔叶、左岛盖部额下回、右中央旁小叶、右楔前叶、右枕中回、双侧舌回及双侧小脑(P均<0.001)。肝硬化患者右岛叶和右豆状壳核的平均ReHo值与间接胆红素浓度呈正相关(r=0.32,P=0.021)。结论血氨正常高间接胆红素肝硬化患者静息态脑功能存在增强和减弱,间接胆红素浓度与部分脑区功能相关,高间接胆红素对成人脑功能也有一定的影响。

Objective To explore the brain function changes in cirrhotic patients with normal blood ammonia and high indirect bilirubin with regional homogeneity（ReHo）of resting-state functional MRI（rs-fMRI）.Methods Fifty-three cirrhotic patients with normal blood ammonia and high indirect bilirubin（cirrhosis group）and 60 healthy volunteers（control group）performed rs-fMRI scans.ReHo values in different brain areas of the two groups were acquired and compared.The correlation between the ReHo values of different brain regions in both groups and the indirect bilirubin concentrations was analyzed.Results Compared with control group,cirrhosis group showed that ReHo values increased in left dorsal-lateral frontal gyrus,left orbital superior frontal gyrus,left top edge of angular gyrus,left precentral gyrus,right caudate,right putamen,right insula,right olfactory cortex（all P〈0.001）,and decreased in left superior occipital gyrus,left middle occipital gyrus,left cuneus,left orbital inferior frontal gyrus,right paracentral lobule,right precuneus,right middle occipital gyrus,bilateral lingual gyrus and bilateral cerebellum（all P〈0.001）.ReHo values in right insula and right putamen in cirrhotic patients positively correlated with indirect bilirubin（r=0.32,P=0.021）.Conclusion The resting state brain function increases and decreases in some brain regions of cirrhotic patients with normal blood ammonia and high indirect bilirubin.Indirect bilirubin level correlates with function of some brain regions,which has certain effect on brain function of adult.