Krieger S, Jauss M, Jansen O, Stiehl A, Sauer P, Geissler M, Theilmann L, Krieger D
Department of Gastroenterology, Ruprecht Karls University of Heidelberg Medical School, Germany.
J Hepatol. 1997 Jul;27(1):121-6. doi: 10.1016/s0168-8278(97)80290-5.
BACKGROUND/AIMS: Deterioration of hepatic encephalopathy is a major concern with the transjugular intrahepatic portosystemic shunt procedure. Symmetric hyperintense globus pallidus on T1-weighted cranial magnetic resonance imaging in patients with liver cirrhosis anticipates hepatocerebral disease. It is hypothesized that hepatic encephalopathy and basal ganglia signal intensity progress in patients with cirrhosis of the liver undergoing transjugular intrahepatic portosystemic shunt.
Twenty-four patients were randomized to undergo either transjugular intrahepatic portosystemic shunt or elective sclerotherapy. At study entry and 6 months after randomization, neurologic assessment, psychometric tests, standard EEG, and magnetic resonance imaging were performed. The severity of liver failure was graded using Child-Pugh's classification. The signal intensity of the globus pallidus was determined on sagittal T1-weighted magnetic resonance imaging.
The T1-weighted signal intensity of the globus pallidus on magnetic resonance imaging significantly increased after transjugular intrahepatic portosystemic shunt placement (p<0.01), but not with elective sclerotherapy. At follow-up, neurological symptoms indicating decline of mental status and motor performance were somewhat more prevalent in transjugular intrahepatic portosystemic shunt patients. Significant deterioration of EEG abnormalities occurred in patients treated with transjugular intrahepatic portosystemic shunt as opposed to elective sclerotherapy (p<0.01).
Transjugular intrahepatic portosystemic shunt procedure increases hyperresonant globus pallidus on magnetic resonance imaging. Neuropsychiatric evaluation shows advancing hepatic encephalopathy, in particular with transjugular intrahepatic portosystemic shunt; however, it does not parallel the augmentation of pallidal signal intensity on magnetic resonance imaging.
背景/目的：肝性脑病的恶化是经颈静脉肝内门体分流术的一个主要问题。肝硬化患者在T1加权头颅磁共振成像上苍白球出现对称性高信号预示着肝脑疾病。据推测，在接受经颈静脉肝内门体分流术的肝硬化患者中，肝性脑病和基底节信号强度会进展。
24例患者被随机分为接受经颈静脉肝内门体分流术或选择性硬化治疗两组。在研究开始时及随机分组后6个月，进行神经学评估、心理测试、标准脑电图和磁共振成像检查。使用Child-Pugh分类法对肝功能衰竭的严重程度进行分级。在矢状面T1加权磁共振成像上测定苍白球的信号强度。
经颈静脉肝内门体分流术放置后，磁共振成像上苍白球的T1加权信号强度显著增加（p<0.01），但选择性硬化治疗组未见增加。随访时，经颈静脉肝内门体分流术患者中提示精神状态和运动功能下降的神经学症状更为普遍。与选择性硬化治疗相比，经颈静脉肝内门体分流术治疗的患者脑电图异常有显著恶化（p<0.01）。
经颈静脉肝内门体分流术可增加磁共振成像上苍白球的高信号。神经精神评估显示肝性脑病在进展，尤其是经颈静脉肝内门体分流术患者；然而，它与磁共振成像上苍白球信号强度的增加并不平行。
