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轻微肝性脑病的特征

Characteristics of minimal hepatic encephalopathy.

作者信息

Amodio Piero, Montagnese Sara, Gatta Angelo, Morgan Marsha Y

机构信息

Clinica Medica 5, CIRMANMEC, University of Padova, Italy.

出版信息

Metab Brain Dis. 2004 Dec;19(3-4):253-67. doi: 10.1023/b:mebr.0000043975.01841.de.

Abstract

The term minimal hepatic encephalopathy refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy. Use of this term emphasizes the fact that the entity of hepatic encephalopathy is a single syndrome with quantitatively distinct features relating to severity. The absence of clinical evidence of hepatic encephalopathy is key to the diagnosis and can only be determined by a detailed assessment of the patients' history and a comprehensive neurological assessment of consciousness, cognitive, and motor function. The neuropsychological features of minimal hepatic encephalopathy point to a disorder of executive functioning, particularly selective attention and psychomotor speed, but other abnormalities may be observed. Alterations in electrophysiological variables have been described; endogenous evoked potentials are, in principle, more likely to reflect the presence of minimal hepatic encephalopathy, since they reflect cognitive phenomena rather than mere stimulus conduction but the specificity of the changes observed is unclear at present. Changes have also been described in the execution of diadochokinetic movements and in the capacity to discriminate flickering light, both of which may have diagnostic potential. The changes observed in cerebral blood flow and metabolism in SPET, PET, and 1H and 31P MRS studies reflect the pathogenic process that underlies the condition rather than providing diagnostic information. Similarly, the morphological brain abnormalities identified in this population, including mild brain oedema, hyperintensity of the globus pallidus and other subcortical nuclei observed in cerebral MR studies, and the central and cortical atrophy observed in neural imaging studies, are unlikely to have diagnostic utility. The presence of minimal hepatic encephalopathy is not without clinical consequence; it has a detrimental effect on health-related quality of life, the ability to perform complex tasks such as driving, and on outcome.

摘要

轻微肝性脑病这一术语是指在没有肝性脑病临床证据的肝硬化患者中可观察到的认知功能、电生理参数、脑神经化学/神经递质稳态、脑血流量、代谢及液体平衡方面的细微变化。使用该术语强调了肝性脑病是一种单一综合征,具有与严重程度相关的数量上不同的特征这一事实。没有肝性脑病的临床证据是诊断的关键,且只能通过详细评估患者病史以及对意识、认知和运动功能进行全面的神经学评估来确定。轻微肝性脑病的神经心理学特征表明存在执行功能障碍,尤其是选择性注意力和精神运动速度方面,但也可能观察到其他异常。已经描述了电生理变量的改变;原则上,内源性诱发电位更有可能反映轻微肝性脑病的存在,因为它们反映的是认知现象而非仅仅是刺激传导,但目前观察到的变化的特异性尚不清楚。也有人描述了轮替运动执行能力和辨别闪烁光能力的变化,这两者都可能具有诊断潜力。单光子发射计算机断层扫描(SPET)、正电子发射断层扫描(PET)以及氢质子磁共振波谱(1H MRS)和磷质子磁共振波谱(31P MRS)研究中观察到的脑血流量和代谢变化反映了该病症的致病过程,而非提供诊断信息。同样,在这一人群中发现的脑形态学异常,包括脑磁共振成像(MR)研究中观察到的轻度脑水肿、苍白球和其他皮质下核的高信号,以及神经影像学研究中观察到的中枢和皮质萎缩,不太可能具有诊断价值。轻微肝性脑病的存在并非没有临床后果;它会对健康相关生活质量、执行诸如驾驶等复杂任务的能力以及预后产生不利影响。

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