基于颅脑静息态功能性核磁共振成像的轻微肝性脑病的临床特征研究

Study on the clinical characteristics of mild hepatic encephalopathy based on fMRI of craniocerebral resting state

目的:探讨基于颅脑静息态功能性核磁共振成像(fMRI)的轻微肝性脑病(MHE)的临床特征,以指导MHE的诊断。方法:选取医院收治的90例肝硬化患者,根据颅脑静息态fMRI结果分为MHE组(32例)和非MHE组(58例),同期选取45名健康体检者设为健康对照组,对比所有受检者数字连接试验(NCT)、数字符号试验(DST)及动物命名测试(ANT)认知功能评估结果,并比较其谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、总胆汁酸(TBA)、白蛋白(AIB)、肌酐、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、淋巴细胞计数及血红蛋白及血氨;采用二元Logistic回归模型分析影响肝硬化患者并发MHE的危险因素;采用绘制受试者工作特征(ROC)曲线分析NCT、DST、ANT、TBA、INR、血氨及血红蛋白预测肝硬化患者并发MHE的效能。结果:MHE组NCT及DST高于非MHE组及健康对照组,ANT低于非MHE组及健康对照组,差异有统计学意义(t_(NCT)=6.374,t=13.702;t_(DST)=9.306,t=19.694;t_(ANT)=8.553,t=10.917;P<0.05)。MHE组的TBA高于非MHE及健康对照组组,差异有统计学意义(t=3.823,t=29.944;P<0.05);MHE组的血氨及血红蛋白高于非MHE组及健康对照组,差异有统计学意义(t_(血氨)=13.132,t=19.709;t_(血红蛋白)=3.138,t=5.618;P<0.05)。Kendall’stau-b相关性分析显示,经静息态fMRI检出的MHE与NCT、DST、TBA、INR及血氨呈正相关性(r=0.438,r=0.587,r=0.286,r=0.407,r=0.657;P<0.05),与ANT及血红蛋白呈负相关(r=-0.685,r=-0.295;P<0.05)。二元Logistic回归分析显示,NCT、DST、TBA、INR、血氨升高和ANT及血红蛋白下降是影响肝硬化患者并发MHE的独立影响因素(OR=1.104,OR=1.481,OR=0.538,OR=13.119,OR=2.324,OR=1.860,OR=0.966;P<0.05)。ROC曲线分析显示,NCT、DST、ANT、TBA、INR、血氨及血红蛋白预测肝硬化患者并发MHE的ROC曲线下面积(AUC)值分别为0.818、0.926、0.903、0.710、0.675、0.981及0.717。结论:MHE患者存在NCT、DST、ANT、TBA、INR、血氨、血红蛋白等指标异常情况,临床动态监测其变化有利于为诊断MHE提供指导。

Objective:To investigate the clinical characteristics of mild hepatic encephalopathy(MHE)based on functional magnetic resonance imaging(fMRI)of craniocerebral resting state.Methods:A total of 90 patients with liver cirrhosis who were diagnosed and treated in hospital were selected as the research objects.They were divided into MHE group(32 cases)and non-MHE group(58 cases)according to the results of craniocerebral resting state fMRI.During the same period,45 healthy subjects who underwent physical examination were divided into health control group.The Number Connection Test(NCT),Number Sign Test(DST),Animal Nomeclature Test(ANT),Alanine Transaminase(ALT),Aspartate Transaminase(AST),Total Bilirubin(TBil),Total Bile Acids(TBA)),albumin(ALB),creatinine,prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),lymphocyte count,hemoglobin and blood ammonia of all subjects were compared.Binary logistic regression model was used to analyze the risk factors that affected the occurrence of complication MHE of patients with liver cirrhosis.The drawn receiver operating characteristics(ROC)curve was used to analyze the efficiencies of NCT,DST,ANT,TBA,INR,blood ammonia and hemoglobin in predicting the complication MHE of patients with liver cirrhosis.Results:The NCT and DST in MHE group were significantly higher than those in non-MHE group and healthy control group,and ANT in MHE group was significantly lower than that in non-MHE group and healthy control group,respectively,and the differences were statistically significant(t_(NCT)=6.374,t=13.702,t_(DST)=9.306,t=19.694,t_(ANT)=8.553,t=10.917,P<0.05).The TBA of MHE group was significantly higher than that of non-MHE group and healthy control group(t=3.823,t=29.944,P<0.05),respectively.Blood ammonia and hemoglobin in MHE group were significantly higher than those in non-MHE group and healthy control group(t_(blood ammonia)=13.132,t=19.709,t_(hemoglobin)=3.138,t=5.618,P<0.05),respectively.Kendall's tau-b correlation analysis showed that MHE detected by resting state fMRI was positively correlated with NCT,DST,TBA,INR and blood ammonia,and it was negatively correlated with ANT and hemoglobin(r=0.438,r=0.587,r=0.286,r=0.407,r=0.657,r=-0.685,r=-0.295,P<0.05),respectively.Binary logistic regression analysis showed that NCT,DST,TBA,INR,increase of blood ammonia and decrease of ANT and hemoglobin were respectively independent influence factors that affected the complication MHE of patients with liver cirrhosis(OR=1.104,OR=1.481,OR=0.538,OR=13.119,OR=2.324,OR=1.860,OR=0.966,P<0.05).ROC curve analysis showed that the area under curve(AUC)values of NCT,DST,ANT,TBA,INR,blood ammonia and hemoglobin were 0.818,0.926,0.903,0.710,0.675,0.981 and 0.717 in predicting complication MHE of patients with liver cirrhosis.Conclusion:MHE patients have abnormal indexes include NCT,DST,ANT,TBA,INR,blood ammonia and hemoglobin,and the clinical dynamic monitoring about their changes is helpful to provide guidance in diagnosing MHE.