Liu Kang, Chen Gang, Ren Shu-Yao, Zhu Yuan-Qiang, Yu Tian-Lei, Tian Ping, Li Chen, Xi Yi-Bin, Wang Zheng-Yu, Ye Jian-Jun, Han Guo-Hong, Yin Hong
Department of Radiology, Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), Xi'an, Shaanxi Province, China.
Department of Radiology, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, Gansu Province, China.
Neural Regen Res. 2019 May;14(5):850-857. doi: 10.4103/1673-5374.249233.
Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting. The main symptom is progressive lower limb dyskinesia. The role of the brain motor control center in hepatic myelopathy is unknown. This study aimed to investigate the gray matter changes in patients with hepatic myelopathy secondary to transjugular intrahepatic portosystemic shunt and to examine their clinical relevance. This was a cross-sectional study. Twenty-three liver failure patients with hepatic myelopathy (hepatic myelopathy group), 23 liver failure patients without hepatic myelopathy (non-hepatic myelopathy group) after transjugular intrahepatic portosystemic shunt, and 23 demographically matched healthy volunteers were enrolled from March 2014 to November 2016 at Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), China. High-resolution magnetization-prepared rapid gradient-echo brain imaging was acquired. Group differences in regional gray matter were assessed using voxel-based morphometry analysis. The relationship between aberrant gray matter and motor characteristics was investigated. Results demonstrated that compared with the non-hepatic myelopathy group, gray matter volume abnormalities were asymmetric, with decreased volume in the left insula (P = 0.003), left thalamus (P = 0.029), left superior frontal gyrus (P = 0.006), and right middle cingulate cortex (P = 0.021), and increased volume in the right caudate nucleus (P = 0.017), corrected with open-source software. The volume of the right caudate nucleus in the hepatic myelopathy group negatively correlated with the lower limb clinical rating of the Fugl-Meyer Assessment (r = -0.53, P = 0.01). Compared with healthy controls, patients with and without hepatic myelopathy exhibited overall increased gray matter volume in both thalami, and decreased gray matter volume in both putamen, as well as in the globus pallidus, cerebellum, and vermis. The gray matter abnormalities we found predominantly involved motor-related regions, and may be associated with motor dysfunction. An enlarged right caudate nucleus might help to predict weak lower limb motor performance in patients with preclinical hepatic myelopathy after transjugular intrahepatic portosystemic shunt. This study was approved by the Ethics Committee of Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), China (approval No. 20140227-6) on February 27, 2014.
肝性脊髓病是慢性肝功能衰竭合并生理性或医源性门体分流患者中出现的一种并发症。主要症状为进行性下肢运动障碍。脑运动控制中心在肝性脊髓病中的作用尚不清楚。本研究旨在调查经颈静脉肝内门体分流术后肝性脊髓病患者的灰质变化，并探讨其临床相关性。这是一项横断面研究。2014年3月至2016年11月，在中国空军军医大学（第四军医大学）西京医院招募了23例患有肝性脊髓病的肝功能衰竭患者（肝性脊髓病组）、23例经颈静脉肝内门体分流术后无肝性脊髓病的肝功能衰竭患者（非肝性脊髓病组）以及23名人口统计学匹配的健康志愿者。采用高分辨率磁化准备快速梯度回波脑成像。使用基于体素的形态学分析评估区域灰质的组间差异。研究异常灰质与运动特征之间的关系。结果表明，与非肝性脊髓病组相比，灰质体积异常不对称，左侧岛叶（P = 0.003）、左侧丘脑（P = 0.029）、左侧额上回（P = 0.006）和右侧扣带回中部（P = 0.021）体积减小，右侧尾状核体积增加（P = 0.017），使用开源软件进行校正。肝性脊髓病组右侧尾状核体积与Fugl-Meyer评估的下肢临床评分呈负相关（r = -0.53，P = 0.01）。与健康对照组相比，有和无肝性脊髓病的患者双侧丘脑灰质体积总体增加，双侧壳核以及苍白球、小脑和蚓部灰质体积减小。我们发现的灰质异常主要累及运动相关区域，可能与运动功能障碍有关。右侧尾状核增大可能有助于预测经颈静脉肝内门体分流术后临床前期肝性脊髓病患者的下肢运动功能减弱。本研究于2014年2月27日获得中国空军军医大学（第四军医大学）西京医院伦理委员会批准（批准号：20140227-6）。
