Campagna Francesca, Montagnese Sara, Schiff Sami, Biancardi Anna, Mapelli Daniela, Angeli Paolo, Poci Carlo, Cillo Umberto, Merkel Carlo, Gatta Angelo, Amodio Piero
Department of Medicine, University of Padua, Padua, Italy.
Liver Transpl. 2014 Aug;20(8):977-86. doi: 10.1002/lt.23909.
The influence of liver transplantation (LT) on mental performance is debated, as is the role of pretransplant overt hepatic encephalopathy (OHE). The aim of this study was to evaluate the time course of the neuropsychological and electroencephalogram (EEG) features of patients with cirrhosis before and after LT with respect to prior OHE. The study population included 65 patients with cirrhosis on the transplant waiting list; 23 had a history of OHE. Each patient underwent an extensive psychometric assessment (10 tests, including paper and pencil tests and a computerized test) and an EEG before and 9 to 12 months after LT. For a subgroup of 11 patients, the assessment was also performed 3 and 6 months after LT. EEGs were analyzed spectrally, and the mean dominant frequencies were obtained. Both psychometric tests and EEGs improved 9 to 12 months after LT. Patients with a history of OHE before LT had worse cognitive performances (P < 0.001) and EEG performances in comparison with their counterparts with a negative history. They also showed greater cognitive improvement after LT (P < 0.01); however, their global cognitive performance remained slightly impaired (P < 0.01). After LT, EEGs normalized for 98% of the patients (P < 0.01), regardless of any history of OHE. In the subgroup of patients evaluated every 3 months, psychometric and EEG findings showed deterioration at 3 months and subsequently steady improvements from 6 months onward. In conclusion, both neuropsychological and EEG performances had significantly improved 1 year after LT. Patients with a history of OHE showed greater improvements after LT than patients with a negative history, but their global cognitive function remained slightly worse; in contrast, EEGs normalized in both groups.
肝移植（LT）对心理表现的影响存在争议，移植前显性肝性脑病（OHE）的作用也同样如此。本研究的目的是评估肝硬化患者在LT前后的神经心理学和脑电图（EEG）特征随时间的变化情况，并与既往OHE情况进行对比。研究人群包括65名在移植等待名单上的肝硬化患者；其中23名有OHE病史。每位患者在LT前以及LT后9至12个月均接受了全面的心理测量评估（10项测试，包括纸笔测试和计算机化测试）以及脑电图检查。对于11名患者的亚组，在LT后3个月和6个月也进行了评估。对脑电图进行频谱分析，得出平均优势频率。心理测量测试和脑电图在LT后9至12个月均有所改善。LT前有OHE病史的患者与无该病史的患者相比，认知表现更差（P < 0.001）且脑电图表现也更差。他们在LT后也表现出更大的认知改善（P < 0.01）；然而，其整体认知表现仍略有受损（P < 0.01）。LT后，98%的患者脑电图恢复正常（P < 0.01），无论有无OHE病史。在每3个月评估一次的患者亚组中，心理测量和脑电图结果显示在3个月时出现恶化，随后从6个月起稳步改善。总之，LT后1年神经心理学和脑电图表现均有显著改善。有OHE病史的患者在LT后比无该病史的患者改善更大，但其整体认知功能仍略差；相比之下两组的脑电图均恢复正常。
