乙肝后肝硬化患者局灶性脑白质高信号与轻微型肝性脑病相关性的MRI研究

Relationship between focal white matter hyperintensity and minimal hepatic encephalopathy in patients with hepatitis B virus-related cirrhosis

目的探讨乙肝后肝硬化患者局灶性脑白质高信号(white matter hyperintensity,WMH)与轻微型肝性脑病(minimal hepatic encephalopathy,MHE)的关系。材料与方法前瞻性收集在我院就诊的乙肝后肝硬化患者38例,其中包括无肝性脑病(non hepatic encephalopathy,n HE)20例,MHE 18例。所有受试者接受神经心理学测验、血液生化检查以及头部磁共振扫描。由2名神经影像医师根据液体衰减反转恢复序列图像评估受试者局灶性WMH的有无及严重程度:Fazekas量表评分0~1分为无或轻度局灶性WMH,Fazekas量表评分≥2分为中重度局灶性WMH。比较n HE与MHE两组间年龄、性别、肝硬化病程、肝功能Child-Pugh分级、静脉血氨浓度、局灶性WMH有无及严重程度的差异;采用多因素logistic回归分析肝硬化患者伴发MHE的独立预测因素;采用Spearman等级相关分析肝硬化患者局灶性WMH与认知功能的相关性。结果在年龄、性别匹配的前提下,MHE组与n HE组相比,中重度局灶性WMH的患者更多,差异有统计学意义(P<0.01);肝硬化病程、肝功能Child-Pugh分级、静脉血氨浓度在两组间差异无统计学意义(P值均>0.05)。多因素logistic回归分析表明中重度局灶性WMH是肝硬化患者伴发MHE的独立预测因素(OR=18.62,95%CI:2.43~142.86;P<0.05)。Spearman等级相关显示:肝硬化患者局灶性WMH的严重程度与数字连接测验-A的完成时间呈显著正相关(r=0.617,P<0.01),与数字符号测验及数字广度测验评分呈显著负相关(r=-0.695,P<0.01;r=-0.558,P<0.01)。结论肝硬化患者的中重度局灶性WMH是MHE的独立预测因素,提示患者可能伴发MHE。

Objective： To explore the relationship between focal white matter hyperintensity（WMH） and minimal hepatic encephalopathy（MHE） in patients with hepatitis B virus-related cirrhosis. Materials and Methods： Thirty-eight patients with hepatitis B virus-related cirrhosis, including 20 n HE and 18 MHE, admitted to our institution were included prospectively. All patients underwent neuropsychological tests, blood biochemical determinations and cerebral magnetic resonance imaging. Fluid attenuated inversion recover（FLAIR） images were reviewed for focal WMH by two neuroradiologists, independently. Those with Fazekas scale scores 0-1 were classified as no or mild focal WMH, while those with Fazekas scale scores≥2 were classified as moderate or severe focal WMH. n HE and MHE groups were compared concerning age, gender, duration of cirrhosis, Child-Pugh scale, venous blood ammonia level and the severity of focal WMH. Multivariate logistic regression analysis was performed to evaluate the independent predictor for MHE. The Spearman rank tests were performed to investigate correlation between the severity of focal WMH and cognitive function. Results： Cpmpared with the age and gender-matched n HE group, there were significantly more patients with moderate or severe focal WMH in MHE group（P〈0.01）. However, duration of cirrhosis, Child-Pugh scale and venous blood ammonia level did not differ significantly between the two groups（all P〈0.05）. Multivariate logistic regression analysis showed that moderate or severe focal WMH was the independent predictor for MHE（OR=18.62, 95% CI： 2.43—142.86, P〈0.05）. Correlation analyses showed significant positive correlation between the severity of focal WMH and completion time of NCT-A（r=0.617, P〈0.01）, significant negative correlations between the severity of focal WMH and scores of DST and digital span test（r=-0.695, P〈0.01, r=-0.558, P〈0.01）. Conclusions： Moderate or severe focal WMH in cirrhotic patients is the independent predictor for MHE, which indicates the possibility of MHE.