肝硬化患者肝移植术后静息态下脑功能局部一致性变化

Changes in regional homogeneity of resting-state cerebral function in patients with liver cirrhosis after liver transplantation

目的探讨肝硬化患者肝移植术前及术后1个月脑功能局部变化。方法本前瞻性研究对象为2012年9月至2013年9月在中山大学附属第三医院岭南医院接受肝移植的11例肝硬化患者(肝硬化组),同期11名健康体检者作为对照组。受试者均签署知情同意书,符合医学伦理学规定。肝硬化组和对照组均为男性,平均年龄分别为(49±9)和(48±8)岁。采用静息态功能MRI(rs-fMRI)研究患者肝移植术前和术后1个月脑功能局部一致性(ReHo)变化。ReHo值比较采用t检验。结果与对照组比较,肝硬化组术前右侧枕中回、左侧颞中回、右侧楔前叶/后扣带回及左侧顶下小叶/中央后回ReHo值明显降低(t=-4.65,-4.56,-4.41,-5.87;P<0.05);术后1个月患者左侧颞中回、后扣带回及右侧顶上小叶/楔前叶ReHo值亦明显降低(t=-4.42,-5.23,-4.41;P<0.05)。肝硬化组肝移植术后1个月扣带中回ReHo值较术前明显升高(t=5.24,P<0.05)。结论肝硬化肝移植患者术前存在脑功能异常,术后1个月脑功能即有改变,但仍未完全恢复正常,可能与肝硬化患者存在某些不可逆损伤有关。

Objective To explore the regional changes of cerebral function in patients with liver cirrhosis before and 1 month after liver transplantation （LT）. Methods A total of 11 patients with liver cirrhosis who underwent LT in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between September 2012 and September 2013 were enrolled in this prospective study （liver cirrhosis group）, and at the same period 11 healthy subjects were enrolled in control group. The informed consents of all patients were obtained and the local ethical committee approval was received. Subjects in liver cirrhosis group and control group were all males, with an average age of （49±9） and （48±8） years old, respectively. Changes of regional homogeneity （ReHo） of the cerebral function in patients of liver cirrhosis group before and 1 month after LT was studied by using resting-state functional MRI （rs-fMRI）. ReHo values were compared between both groups by t test. Results Compared with control group, Re Ho values of right middle occipital gyrus, left middle temporal gyrus, right precuneus/posterior cingulate gyrus, left inferior parietal lobule/postcentral gyrus in liver cirrhosis group significantly decreased before LT （t=-4.65, -4.56, -4.4l, -5.87; P〈0.05）, and those of left middle temporal gyrus, posterior cingulate gyrus, right superior parietal lobule/precuneus also significantly decreased 1 month after LT （t=-4.42, -5.23, -4.41; P〈0.05）. The ReHo value of middle cingulate gyms 1 month after LT was significantly higher than that before LT （t=5.24, P〈0.05）. Conclusions Cerebral dysfunction is observed in patients with liver cirrhosis before LT, and it can change within 1 month after LT, but cannot get a full recovery, which may be related to some irreversible injuries of patients with liver cirrhosis.