Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2019 Feb 8;14(2):e0211906. doi: 10.1371/journal.pone.0211906. eCollection 2019.
Many patients with primary biliary cholangitis (PBC) experience non-hepatic symptoms that are possibly linked to altered interoception, the sense of the body's internal state. We used magnetic resonance imaging (MRI) to determine if PBC patients exhibit structural and functional changes of the thalamus and insula, brain regions that process signals related to interoception.
Fifteen PBC patients with mild disease and 17 controls underwent 3 Tesla T1-weighted MRI, resting-state functional MRI, and quantitative susceptibility mapping (QSM), to measure thalamic and insular volume, neuronal activity and iron deposition, respectively. Group differences were assessed using analysis of covariance, and stepwise linear regression was used to determine the predictive power of clinical indicators of disease.
PBC patients exhibited reduced thalamic volume (p < 0.01), and ursodeoxycholic acid (UDCA) non-responders exhibited lower left thalamus activity (p = 0.05). PBC patients also exhibited reduced anterior insula activity (p = 0.012), and liver stiffness positively correlated with MRI indicators of anterior insula iron deposition (p < 0.02).
PBC affects structure and function of brain regions critically important to interoception. Moreover, these brain changes occur in patients with early, milder disease and thus may potentially be reversible.
许多原发性胆汁性胆管炎 (PBC) 患者存在非肝脏症状，这些症状可能与内脏感知改变有关，即对身体内部状态的感知。我们使用磁共振成像 (MRI) 来确定 PBC 患者是否存在丘脑和脑岛的结构和功能变化，这些脑区处理与内脏感知相关的信号。
15 名轻度 PBC 患者和 17 名对照者接受了 3T T1 加权 MRI、静息态功能 MRI 和定量磁化率映射 (QSM)，分别测量丘脑和脑岛的体积、神经元活动和铁沉积。使用协方差分析评估组间差异，并进行逐步线性回归以确定疾病临床指标的预测能力。
PBC 患者表现出丘脑体积减小（p<0.01），熊去氧胆酸（UDCA）无应答者左侧丘脑活动降低（p=0.05）。PBC 患者还表现出前脑岛活动减少（p=0.012），肝脏硬度与前脑岛铁沉积的 MRI 指标呈正相关（p<0.02）。
PBC 影响对内脏感知至关重要的脑区的结构和功能。此外，这些脑变化发生在疾病早期、更轻度的患者中，因此可能具有潜在的可逆转性。
