Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
J Hepatol. 2011 Sep;55(3):564-573. doi: 10.1016/j.jhep.2010.12.008. Epub 2010 Dec 14.
BACKGROUND & AIMS: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis.
Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features.
Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11months (7-50months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter.
These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study.
我们应用先进的磁共振成像和基于体素的形态计量分析来评估肝硬化患者的脑组织密度。
48 例无显性肝性脑病的肝硬化患者（17 例 Child A、13 例 Child B 和 18 例 Child C）和 51 名健康对照者按年龄和性别匹配。17 例患者有显性肝性脑病病史，其中 8 例在纳入时患有轻微肝性脑病，另外 10 例在纳入时患有轻微肝性脑病但无先前显性肝性脑病病史，21 例患者无上述特征。
肝硬化患者的灰质和白质许多区域的脑密度降低。酒精性肝硬化患者的病变区域的范围和大小大于病毒性肝炎后肝硬化患者，且与肝功能衰竭和脑功能障碍的程度直接相关（通过神经心理学测试和显性肝性脑病的病史来评估）。12 例接受肝移植的肝硬化患者在肝移植后中位数时间 11 个月（7-50 个月）后进行了探索。在肝移植时，3 例患者属于 Child-Pugh 分类的 A 级，5 例属于 B 级，4 例属于 C 级。与健康对照组相比，肝移植患者的灰质和白质均存在脑密度降低的区域。
这些结果表明，肝硬化患者的脑组织密度丢失很常见，在疾病过程中进展，在有肝性脑病病史的患者中更为严重，并在肝移植后持续存在。从目前的研究中无法确定这种异常的意义、病理生理学和临床相关性。
