Hassan Elham A, Abd El-Rehim Abeer S, Seifeldein Gehan S, Shehata Ghaydaa A
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Arab J Gastroenterol. 2014 Sep-Dec;15(3-4):108-13. doi: 10.1016/j.ajg.2014.09.003. Epub 2014 Nov 11.
Minimal hepatic encephalopathy (MHE) is a subtle complication of cirrhosis that may have a detrimental effect on daily functioning and may progress to overt hepatic encephalopathy (HE). The aims of this study were to identify MHE and assess neuropsychological changes in those patients.
A case-control study was conducted in 35 cirrhotic patients. MHE was identified by brain (hydrogen-1) magnetic resonance spectroscopy ((1)H-MRS). Neuropsychological changes were evaluated using cognitive abilities screening instrument (CASI) test, Hamilton depression scale, and soft neurological sign assessment.
Of the patients, 16 (45.7%) had significant brain (1)H-MRS findings suggesting MHE in the form of decreased myo-Inositol/creatine (mI/Cr) and choline/creatine (Cho/Cr) ratios and increased glutamine-glutamate/creatine (Glx/Cr) ratios in white and grey matters compared to patients without MHE and healthy controls. Patients with MHE had significantly lower abstract thinking subset and total CASI score in comparison to patients without MHE (p=0.03 and p=0.05, respectively) and controls (p=0.003 and p=0.02, respectively). No statistically significant differences were observed amongst different groups regarding other CASI subsets, depression, and soft neurological assessment in spite of a tendency towards increased values in patients with MHE.
MHE associated with neurophysiological changes demonstrated by (1)H-MRS preceded neuropsychological changes. Thus, (1)H-MRS may be considered as a potential tool for diagnosis of cirrhosis-associated cerebral dysfunction and a promising method for prioritisation of subjects awaiting liver transplantation.
轻微肝性脑病（MHE）是肝硬化的一种隐匿并发症，可能对日常功能产生不利影响，并可能进展为显性肝性脑病（HE）。本研究的目的是识别MHE并评估这些患者的神经心理学变化。
对35例肝硬化患者进行了病例对照研究。通过脑（氢-1）磁共振波谱（（1）H-MRS）识别MHE。使用认知能力筛查工具（CASI）测试、汉密尔顿抑郁量表和软性神经体征评估来评估神经心理学变化。
在这些患者中，16例（45.7%）有显著的脑（1）H-MRS结果，提示存在MHE，表现为与无MHE的患者及健康对照相比，白质和灰质中的肌醇/肌酸（mI/Cr）和胆碱/肌酸（Cho/Cr）比值降低，谷氨酰胺-谷氨酸/肌酸（Glx/Cr）比值升高。与无MHE的患者相比，MHE患者的抽象思维子项和CASI总分显著更低（分别为p=0.03和p=0.05），与对照组相比也显著更低（分别为p=0.003和p=0.02）。尽管MHE患者有升高的趋势，但在不同组之间，关于其他CASI子项、抑郁和软性神经评估方面未观察到统计学显著差异。
（1）H-MRS显示的与神经生理学变化相关的MHE先于神经心理学变化出现。因此，（1）H-MRS可被视为诊断肝硬化相关脑功能障碍的潜在工具，以及对等待肝移植的患者进行优先排序的有前景的方法。
