Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China.
J Neurol Sci. 2012 Oct 15;321(1-2):65-72. doi: 10.1016/j.jns.2012.07.056. Epub 2012 Aug 9.
White matter (WM) abnormalities are common in cirrhotic patients and possibly contribute to hepatic encephalopathy (HE), a frequent neuropsychiatric complication of cirrhosis. However, little is known about these WM abnormalities and their relationship to neurocognitive deficits in patients with HBV-related cirrhosis.
Three-dimensional T1-weighted magnetic resonance imaging and diffusion tensor imaging (DTI) scans were obtained from 67 patients with HBV-related cirrhosis and 40 controls. Voxel-based morphometry and voxel-based DTI were performed to detect macroscopic atrophy and damage to the microstructural integrity of the WM, respectively. Correlation analyses were performed to investigate the relationships between WM abnormalities and neurocognitive performances.
Patients with cirrhosis exhibited significantly decreased WM volume and fractional anisotropy (FA) values, especially in the corpus callosum, thalamus, extra-nuclear area, sensorimotor area, fusiform gyrus, lingual gyrus, and frontal lobes. These abnormalities were more severe with increasing Child-Pugh stage, minimal HE, and previous overt HE. Changes in the corpus callosum, frontal lobe, sensorimotor area, internal capsule, and temporal-occipital lobes were correlated with poor neurocognitive performance. Also, the significantly decreased global WM volume and mean FA value were correlated with poor neurocognitive performances.
Diffuse WM abnormalities are common in patients with HBV-related cirrhosis. Advanced liver disease and episodes of HE are two factors associated with WM abnormalities. The correlation between poor neurocognitive performance and WM abnormalities suggests that WM abnormalities may be one of mechanisms underlying neurocognitive deficits in patients with HBV-related cirrhosis.
肝硬化患者常出现脑白质（WM）异常，这可能导致肝性脑病（HE），这是肝硬化常见的神经精神并发症。然而，对于这些 WM 异常及其与乙型肝炎病毒（HBV）相关肝硬化患者神经认知缺陷的关系，我们知之甚少。
对 67 例 HBV 相关肝硬化患者和 40 例对照者进行了三维 T1 加权磁共振成像和弥散张量成像（DTI）扫描。分别采用基于体素的形态测量和基于体素的 DTI 来检测宏观萎缩和 WM 微观结构完整性的损伤。进行相关性分析以研究 WM 异常与神经认知表现之间的关系。
肝硬化患者的 WM 体积和各向异性分数（FA）值明显降低，特别是在胼胝体、丘脑、核外区、感觉运动区、梭状回、舌回和额叶。这些异常在随着 Child-Pugh 分级、轻微型肝性脑病和既往显性肝性脑病的增加而变得更严重。胼胝体、额叶、感觉运动区、内囊和颞枕叶的改变与神经认知表现较差相关。此外，明显降低的全脑 WM 体积和平均 FA 值与神经认知表现较差相关。
HBV 相关肝硬化患者存在弥漫性 WM 异常。进展性肝病和 HE 发作是与 WM 异常相关的两个因素。神经认知表现较差与 WM 异常之间的相关性提示 WM 异常可能是 HBV 相关肝硬化患者神经认知缺陷的机制之一。
