Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, School of Medicine, Redwood City, CA 94063, USA.
Department of Psychiatry & Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Rd. Stanford, CA 94305, USA; Neuroscience Program, SRI International, Menlo Park, CA 94025, USA.
Neuroimage Clin. 2023;37:103333. doi: 10.1016/j.nicl.2023.103333. Epub 2023 Jan 27.
The CNS manifestation of chronic liver disease can include magnetic resonance (MR) signal hyperintensities in basal ganglia structures. Here, relations between liver (serum-derived fibrosis scores) and brain (regional T1-weighted signal intensities and volumes) integrity were evaluated in a sample of 457 individuals including those with alcohol use disorders (AUD), people living with human immunodeficiency virus (HIV), those comorbid for AUD and HIV, and healthy controls. Liver fibrosis was identified from cutoff scores as follows: aspartate aminotransferase to platelet ratio index (APRI) > 0.7 in 9.4% (n = 43) of the cohort; fibrosis score (FIB4) > 1.5 in 28.0% (n = 128) of the cohort; and non-alcoholic fatty liver disease fibrosis score (NFS) > -1.4 in 30.2% (n = 138) of the cohort. Presence of serum-derived liver fibrosis was associated with high signal intensities selective to basal ganglia (i.e., caudate, putamen, and pallidum) structures. High signal intensities in the pallidum, however, explained a significant portion of the variance in APRI (25.0%) and FIB4 (23.6%) cutoff scores. Further, among the regions evaluated, only the globus pallidus showed a correlation between greater signal intensity and smaller volume (r = -0.44, p <.0001). Finally, higher pallidal signal intensity correlated worse ataxia (eyes open ρ = -0.23, p =.0002; eyes closed ρ = -0.21, p =.0005). This study suggests that clinically relevant serum biomarkers of liver fibrosis such as the APRI may identify individuals vulnerable to globus pallidus pathology and contribute to problems with postural balance.
慢性肝脏疾病的中枢神经系统表现可包括基底节结构的磁共振（MR）信号高信号。在这里，我们评估了包括酒精使用障碍（AUD）患者、人类免疫缺陷病毒（HIV）感染者、AUD 和 HIV 共病患者以及健康对照者在内的 457 名个体的肝脏（血清纤维化评分）和大脑（区域 T1 加权信号强度和体积）完整性之间的关系。通过截断分数确定肝纤维化如下：队列中有 9.4%（n=43）的患者天门冬氨酸氨基转移酶与血小板比值指数（APRI）>0.7；队列中有 28.0%（n=128）的患者纤维化评分（FIB4）>1.5；队列中有 30.2%（n=138）的患者非酒精性脂肪性肝病纤维化评分（NFS）>−1.4。存在血清来源的肝纤维化与基底节（即尾状核、壳核和苍白球）结构的高信号强度选择性相关。然而，苍白球的高信号强度解释了 APRI（25.0%）和 FIB4（23.6%）截断评分的大部分方差。此外，在评估的区域中，只有苍白球显示信号强度越高与体积越小之间存在相关性（r=-0.44，p<.0001）。最后，较高的苍白球信号强度与更严重的共济失调相关（睁眼时 ρ=-0.23，p=.0002；闭眼时 ρ=-0.21，p=.0005）。本研究表明，临床相关的肝纤维化血清生物标志物，如 APRI，可能识别出易受苍白球病理影响的个体，并导致姿势平衡问题。
