乙型肝炎后肝硬化患者脑皮层下结构体积改变的MRI研究

Volume changes of subcortical structures in patients with post-hepatitis B cirrhosis:A magnetic resonance imaging study

目的:探讨乙型肝炎后肝硬化患者脑皮层下结构的体积改变。方法:选择在中南大学湘雅三医院就诊的乙型肝炎后肝硬化患者30例作为肝硬化组,以及年龄、性别匹配的健康人24例作为对照组。所有受试者接受神经心理学测验、血液生化检查以及头部MRI扫描。采用FreeSurfer软件分析受试者18个皮层下结构的体积。分析肝硬化组患者异常的皮层下结构的体积与临床指标及神经认知功能的相关性;分析苍白球体积与苍白球高信号的相关性。结果:与对照组比较,肝硬化组患者双侧壳核、杏仁核、伏隔核体积缩小,双侧苍白球体积增大(P<0.001或P=0.001);并且,患者左侧壳核及杏仁核体积与数字连接测验A(number connection test-A,NCT-A)呈负相关(左侧壳核:r=-0.410,P=0.034;左侧杏仁核:r=-0.439,P=0.022),双侧苍白球体积与苍白球指数(pallidal index,PI)呈正相关(左侧:r=0.889,P<0.001;右侧:r=0.900,P<0.001)。结论:乙型肝炎后肝硬化患者多个皮层下结构的体积存在异常,患者神经认知功能损害可能与左侧壳核以及杏仁核萎缩有关,锰沉积可能引起双侧苍白球体积增大。

Objective:To investigate volume changes of subcortical structures in patients with posthepatitis B cirrhosis.Methods:Thirty patients with post-hepatitis B cirrhosis(the cirrhosis group)and 24 ageand sex-matched healthy controls(the control group)were enrolled in this prospective study.All subjects underwent neuropsychological tests,blood biochemical determinations,and cerebral MRI.Volumes of 18 selected subcortical structures were automatically segmented and analyzed by the Free Surfer.In the cirrhosis group,the relationships between abnormal subcortical volumes and clinical index or neurocognitive performance were investigated.The relationships between globus pallidus volumes and pallidal hyperintensity were also examined.Results:Compared with the healthy controls,patients with post-hepatitis B cirrhosis displayed smaller bilateral putamen,amygdala,and nucleus accumbens volumes and larger bilateral globus pallidus volumes(P<0.001 or P=0.001).In the cirrhosis group,the volumes of left putamen and amygdala were negatively correlated with the number connection test-A(NCT-A)(left putamen r=-0.410,P=0.034;left amygdala r=-0.439,P=0.022),and the volumes of bilateral globus pallidus were positively correlated with pallidal index(PI)(left globus pallidus r=0.889,P<0.001;right globus pallidus r=0.900,P<0.001).Conclusion:Abnormalities of subcortical volumes appear bilaterally symmetrical in patients with post-hepatitis B cirrhosis.Atrophy of left putamen and amygdala might contribute to poor neurocognitive performance,and the manganese deposition might contribute to the increased globus pallidus volumes in patients with post-hepatitis B cirrhosis.