【摘要】：目的觀察肝硬化(HC)繼發(fā)輕微肝性腦病(MHE)患者大腦灰質(zhì)結(jié)構(gòu)和功能改變特征。方法對(duì)單純HC患者30例(單純HC組)、HC伴發(fā)MHE患者32例(MHE組)、健康對(duì)照34名(對(duì)照組)行神經(jīng)心理學(xué)測(cè)試及結(jié)構(gòu)與功能MR掃描,基于體素的形態(tài)學(xué)及局部一致性(ReHo)方法,分析大腦灰質(zhì)結(jié)構(gòu)和ReHo改變。結(jié)果 MHE組完成NCT-A時(shí)間較單純HC組及對(duì)照組明顯增高,而MHE組DST評(píng)分明顯降低(P均0.001)。與對(duì)照組比較,MHE組灰質(zhì)體積改變的區(qū)域和強(qiáng)度明顯增加。尾狀核與眶部額內(nèi)側(cè)回(MFG)體積縮小和丘腦增大僅見于MHE組。雙側(cè)丘腦ReHo降低僅見于單純HC組,雙側(cè)輔助運(yùn)動(dòng)區(qū)(SMA)、內(nèi)側(cè)額上回(SFG)及前扣帶回(ACC)ReHo顯著降低主要見于MHE組。單純HC和MHE組丘腦體積與平均ReHo值呈正相關(guān)(r=0.342,P=0.007)。MHE組丘腦體積與眶部MFG體積改變呈正相關(guān)(r=0.448,P=0.01);SMA、ACC及內(nèi)側(cè)SFG平均ReHo值與NCT-A完成時(shí)間呈負(fù)相關(guān)(r=-0.529、-0.414、-0.450,P均0.05),與DST評(píng)分呈正相關(guān)(r=0.562、0.483、0.459,P均0.05)。結(jié)論聯(lián)合結(jié)構(gòu)與功能MRI研究可能為MHE診斷和發(fā)病機(jī)制提供更可靠的客觀依據(jù),丘腦、尾狀核、額葉及扣帶回體積與ReHo改變可能是MHE大腦結(jié)構(gòu)與功能損傷的MRI影像特征。
[Abstract]:Objective to observe the changes of gray matter structure and function in patients with mild hepatic encephalopathy (MHE) secondary to liver cirrhosis (HC). Methods 30 patients with HC (32 patients with), HC accompanied with MHE in HC group (MHE group) and 34 healthy controls (control group) underwent neuropsychological tests and structural and functional MR scans. The changes of brain gray matter structure and ReHo were analyzed based on morphologic and local consistent (ReHo) method of voxel. Results the time to complete NCT-A in MHE group was significantly higher than that in HC group and control group, while the DST score in MHE group was significantly lower (P 0.001). Compared with the control group, the area and intensity of gray matter volume change in MHE group were significantly increased. The (MFG) volume of caudate nucleus and orbital medial frontal gyrus decreased and thalamus enlarged only in MHE group. The decrease of ReHo in bilateral thalamus was found only in simple HC group. The decrease of (SFG) in medial superior frontal gyrus of (SMA), and (ACC) ReHo in anterior cingulate gyrus in bilateral auxiliary motor area was mainly found in MHE group. There was a positive correlation between the volume of thalamus and the mean ReHo in HC and MHE groups (r = 0.342P ~ (0.007). There was a positive correlation between the volume of thalamus and the volume of MFG in orbit (r = 0.448). The mean ReHo value of SMA,ACC and medial SFG was negatively correlated with the completion time of NCT-A (r = 0. 529 ~ 0. 414 ~ 0. 450) and positively correlated with the DST score (r = 0. 562P = 0. 483n, P = 0. 05). Conclusion the study of combined structure and function MRI may provide a more reliable objective basis for the diagnosis and pathogenesis of MHE. The changes of thalamus, caudate nucleus, frontal lobe and cingulate gyrus volume and ReHo may be the MRI imaging features of MHE brain structure and function injury.
【作者單位】： 白求恩國際和平醫(yī)院放射科;第三軍醫(yī)大學(xué)西南醫(yī)院放射科;第三軍醫(yī)大學(xué)西南醫(yī)院感染科;
【基金】：河北省自然科學(xué)基金(H2014505007)
【分類號(hào)】：R575.3;R445.2

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